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

•Quality indicators improvement for HIV-exposures patients in the ED.•A prospective observational 3-years pre- and post-intervention study.•The implementation of rules for HIV exposure improved triage performance.•Simulation training reduced time to access to post exposure prophylaxis (PEP). Health...

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Veröffentlicht in:International emergency nursing 2019-11, Vol.47, p.100786, Article 100786
Hauptverfasser: Casalino, Enrique, Kenway, Philippe, Bouzid, Donia, Goncalves, Suzanne, Antoniol, Stephanie, Radou, Lorene, Choquet, Christophe, Macaux, Michelle, Ghazali, Daniel Aiham
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container_issue
container_start_page 100786
container_title International emergency nursing
container_volume 47
creator Casalino, Enrique
Kenway, Philippe
Bouzid, Donia
Goncalves, Suzanne
Antoniol, Stephanie
Radou, Lorene
Choquet, Christophe
Macaux, Michelle
Ghazali, Daniel Aiham
description •Quality indicators improvement for HIV-exposures patients in the ED.•A prospective observational 3-years pre- and post-intervention study.•The implementation of rules for HIV exposure improved triage performance.•Simulation training reduced time to access to post exposure prophylaxis (PEP). Health 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. A 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)). A 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 
doi_str_mv 10.1016/j.ienj.2019.100786
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Health 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. A 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)). A 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 &lt; 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 &lt; 0.0001). Time interval quality indicators (minutes) were: ED arrival-Triage Nurse 10.9 ± 9.6 vs. 9.1 ± 4.8 (P &lt; 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 &lt; 0.0001). These results suggest that time interval HIV-exposure to ED arrival can be used as a triage criterion. 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Time interval quality indicators (minutes) were: ED arrival-Triage Nurse 10.9 ± 9.6 vs. 9.1 ± 4.8 (P &lt; 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 &lt; 0.0001). These 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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31488346</pmid><doi>10.1016/j.ienj.2019.100786</doi><orcidid>https://orcid.org/0000-0002-7538-3320</orcidid><orcidid>https://orcid.org/0000-0003-0129-4322</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elsevier ScienceDirect Journals Complete; Applied Social Sciences Index & Abstracts (ASSIA)
subjects Chi-Square Distribution
Emergency department
Emergency services
Female
Health education
HIV
HIV exposure
HIV Infections - diagnosis
HIV Infections - psychology
Human immunodeficiency virus
Humans
Intervention
Life Sciences
Male
Middle Aged
Nurses
Occupational Exposure - adverse effects
Post exposure prophylaxis
Professional training
Prospective Studies
Quality indicators
Quality management
Simulation
Simulation training
Time Factors
Triage
Triage - methods
Triage - trends
title Implementation of HIV-exposures triage strategy in emergency departments to improve nurse-triage for HIV-exposures: A pre- and post-intervention period study
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