Outcomes 10 Years After Implementing an Emergency Department Opt-out Bloodborne Virus Screening Program
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By
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Liam Townsend
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Fiona Herraghty
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Seán Brennan
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Conor Grant
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Wenzhou Wang
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Anne Moriarty
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Yvonne Lynagh
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Lorraine Clancy
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Antoinette Power
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Brendan Crowley
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Suzanne Norris
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Darragh Shields
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Colm Bergin
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September 11, 2025
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Clinical Scorecard: Ten-Year Results of an Opt-Out Bloodborne Virus Screening Initiative in an Urban Emergency Department
At a Glance
| Category | Detail |
|---|
| Condition | Bloodborne viruses including HIV, hepatitis B (HBV), and hepatitis C (HCV) |
| Key Mechanisms | Opt-out screening of ED patients undergoing phlebotomy with combined HIV, HBV, and HCV testing; linkage to care for positive cases |
| Target Population | Adult emergency department patients undergoing phlebotomy with intact decision-making capacity |
| Care Setting | Urban tertiary referral hospital emergency department |
Key Highlights
- High acceptance rate of BBV screening among phlebotomized ED patients (81%) sustained over 10 years
- Significant reduction in PCR-positive HCV diagnoses despite stable rates of new HIV, HBV, and HCV antibody diagnoses
- High linkage to care rates for newly diagnosed patients: 96% HIV, 89% HBV, 95% HCV
Guideline-Based Recommendations
Diagnosis
- Offer routine opt-out BBV screening to all adult ED patients undergoing phlebotomy
- Use combined HIV antibody/antigen, HCV antibody, and HBV surface antigen testing on a single serum sample
- Perform PCR testing for HCV RNA on all HCV antibody-positive samples unless recently screened
Management
- Ensure prompt linkage to specialist care for patients with positive BBV diagnoses
- Repeat screening without restriction to capture new infections and relink lost-to-follow-up patients
Monitoring & Follow-up
- Track acceptance rates and new diagnosis rates longitudinally to assess program impact
- Monitor linkage to care rates and barriers, especially for patients discharged directly from ED
Risks
- Potential missed diagnoses if patients decline screening or are not undergoing phlebotomy
- Risk of loss to follow-up if linkage to care is not maintained, particularly among people who inject drugs
Patient & Prescribing Data
Adult ED patients undergoing phlebotomy in an urban tertiary hospital
High linkage to care achieved for BBV-positive patients supports effectiveness of opt-out screening in facilitating treatment initiation
Clinical Best Practices
- Integrate BBV opt-out screening into routine ED phlebotomy workflows with electronic health record order sets
- Provide patient information and verbal consent emphasizing screening as standard care with opt-out option
- Repeat screening without requiring prior test history to maximize coverage in high-risk populations
- Focus on linkage to care pathways, especially for patients discharged directly from ED and people who inject drugs
References
