Weighing Longer Lengths of Stay Against Potential Hepatitis C Detection

Though testing patients in the emergency department for hepatitis C adds time to their length of stay, the benefits of detection are self-evident.

Screening for hepatitis C virus (HCV) means a modestly longer length of stay (LOS) in the emergency department (ED), according to a recent study. Conducted by Douglas A. E. White of the Department of Emergency Medicine at Alameda Health System, Highland Hospital in Oakland, CA, and colleagues, the study was published in PLOS One On October 19, 2016.

“The surprisingly high rates of undiagnosed HCV infection among ED patients highlights the import role EDs could play in combating the HCV epidemic through screening, disease identification, and linkage to care and treatment,” say the authors. However, no studies have addressed how HCV screening impacts LOS. Thus, the researchers say, “The objective of this study is to assess the impact of a streamlined and integrated HCV screening protocol on ED LOS for patients discharged from the ED.”

In order to explore the issue, the researchers conducted a retrospective cohort study in which they compared LOS of patients who were screened for HCV and those who were not. “From April 2014 through March 2015, there were 83,721 visits to the ED” at the Alameda Health System - Highland Hospital, say the researchers. There 69,639 records with enough data to be included in the study. Patients were either treated in the Main ED or sent to the Fast Track (FT).

The researchers found 44,027 unique patients, of whom 45,852 (66%) were treated in the Main ED. “There were 2,864 HCV screening tests completed, of which 272 (9,5%) were antibody positive,” report the researchers. Both being seen in the Main ED and a complete blood count (CBC) were associated with an HCV screening. However, there was no significant difference in the rate of antibody positivity regardless of location of services or whether or not a CBC was conducted.

“The median LOS among all 69,639 visits to the Main ED and FT was 120 minutes,” say the researchers, and, they add that the median for visits that included an HCV screening “was 151 minutes.” When a CBC was performed there was no difference in LOS whether an HCV screening occurred or not.

Although an HCV screening “modestly prolongs overall LOS throughout the ED,” say the researchers, “among patients undergoing other blood tests, HCV screening had no significant effect on LOS.” They suggest that emergency departments face the decision of whether the public health benefit outweighs quality metrics like LOS. They conclude, “Future programs should consider routinely offering HCV screening to patients who are undergoing laboratory testing.”

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