• Int Emerg Nurs · Nov 2019

    Implementation of HIV-exposures triage strategy in emergency departments to improve nurse-triage for HIV-exposures: A pre- and post-intervention period study.

    • Enrique Casalino, Philippe Kenway, Donia Bouzid, Suzanne Goncalves, Stephanie Antoniol, Lorene Radou, Christophe Choquet, Michelle Macaux, and Daniel Aiham Ghazali.
    • Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France; Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 7334 « Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES) », Paris, France.
    • Int Emerg Nurs. 2019 Nov 1; 47: 100786.

    BackgroundHealth Education in the emergency department (ED) is one of the tasks that the HIV-exposure triage implementation needs to be considered. No triage training has been evaluated.MethodsA prospective 3-years pre- and post-intervention study in an urban academic ED was realized. The intervention was a simulation-based training on triage rules for triage nurses. Triage is based on time between HIV-exposure and ED arrival (≤48 h: level 2 (urgent); ≥48 h: level 5 (non-urgent)).FindingsA total of 2011 HIV-exposures were included; 15.1 per cent were well triaged in pre-intervention vs. 88 per cent in post-intervention period (P < 0.0001). Among well-triaged patients as level 2, the post-exposure prophylaxis prescription rate increased from 30.5 to 57.6 per cent (P < 0.0001). Time interval quality indicators (minutes) were: ED arrival-Triage Nurse 10.9 ± 9.6 vs. 9.1 ± 4.8 (P < 0.0001), ED arrival-Physician 56.3 ± 26.0 vs. 49.9 ± 36.0 (P = 0.0001), and ED arrival to Post-exposure prophylaxis first-dose 86.9 ± 30.0 vs. 65.2 ± 42.0 (P < 0.0001).ConclusionsThese results suggest that time interval HIV-exposure to ED arrival can be used as a triage criterion. A continuous quality improvement program for PEP after HIV-exposure based on a nurse triage training program achieved the objectives of optimizing the triage performance by reducing the time to access the post-exposure prophylaxis first-dose.Copyright © 2019 Elsevier Ltd. All rights reserved.

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