(051) Brief Educational and Process Change Quality Improvement Intervention Increases HIV, Hepatitis C, and Syphilis Screening in Psychiatric Inpatients Admitted from a Psychiatric Emergency Service

Abstract:

Background:
Psychiatric disorders increase risk for infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and syphilis, and these infections carry implications for psychiatric symptoms and treatment (Campos, 2008). At the University of New Mexico Psychiatric Center (UNMPC), no standardized protocol existed for HIV, HCV, and syphilis screening among patients admitted for psychiatric hospitalization.


Methods:
In January 2020, residents and faculty at UNMPC began a quality improvement intervention aimed at increasing screening rates of HIV, HCV, and syphilis among patients admitted for hospitalization from the psychiatric emergency service. The intervention consisted of four components: Safe Zone training for residents; addition of HIV, HCV, and syphilis testing prompts to the admission orders in the electronic health record (EHR); resident education about screening and consent; and posted reminders at resident workstations. Retrospective evaluation of de-identified EHR admissions data compared screening rates over the nine months post-intervention versus the nine months pre-intervention. Secondary evaluations investigated whether onset of the COVID-19 in New Mexico in March 2020, or the start of the new resident class in July 2020, affected screening rates post-intervention. Pearson chi-square analyses tested for screening rate differences. This study was approved by the UNM Human Research Protections Office.


Results:
Screening rates for all conditions increased post-intervention. HIV screening increased from 7.7 to 14.4%, Χ² (1, 1838) = 20.89, p < .001, HCV from 4.9 to 15.3% Χ² (1, 1838) = 54.66, p < .001, and syphilis from 15.6 to 21.5%, Χ² (1, 1838) = 10.60, p = .001. Neither COVID-19, Χ² (1, 488) = 0.31, p = .579, nor start of the new resident class, Χ² (1, 679) = 0.03 p = .863, impacted screening rates post-intervention.


Discussion:
This brief quality improvement intervention significantly increased screening rates for HIV, HCV, and syphilis in psychiatric inpatients admitted from the psychiatric emergency service. However, even post-intervention, screening rates remained low. These findings mirror previously published data on the impact of a low-intensity administrative advocacy and in-service training intervention on HIV screening rates in psychiatric inpatients (Shumway, 2018).

Conclusion/Implications:
In light of the bidirectional risks of psychiatric disorders and infection with HIV, HCV, and/or syphilis, and in keeping with United States Preventive Service Task Force guidelines pertaining to screening for these infectious diseases, further quality improvement initiatives remain necessary for increasing screening amongst persons admitted for psychiatric hospitalization (USPSTF, 2022).

References:
Campos LN, Guimaraes MD, Carmo RA, et al. HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature. Cad Saude Publica. 2008 24(Suppl 4):s607–20

Shumway M, Mangurian C, Carraher N, et al. Increasing HIV testing in inpatient psychiatry. Psychosomatics 2018 59(2):186-192

United States Preventive Services Taskforce. (n.d.). Retrieved April 3, 2022, from https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P&category%5B%5D=18&searchterm=