HIV, STIs and Viral Hepatitis Routine Screening Emergency Department Toolkit: Linkage to care

The routine screening process does not simply end with diagnosis. Care team members must be confident and clear on next steps after result notification. Inadequate linkage to care processes and procedures in emergency departments prevents clinicians from initiating routine screening. Emergency departments are often reluctant to conduct routine screening if they cannot guarantee appropriate follow up and linkage to care. It can also be a struggle to obtain reliable patient contact information to follow up with result disclosure. 

Without a strong linkage to care infrastructure, positive results fall in the patient’s hands, leaving a huge responsibility on the individual to seek and manage treatment, often resulting in the patient being lost to care. Routine screening is also critical for re-linking people previously diagnosed back to care.

• Day-to-day unpredictability with patients in precarious situations 
• Inconsistent patient contact information 
• Multiple follow-ups needed to bring patients back into care 
• Patient resistance to initiating long term treatment

1. Form a strong referral network 

A robust referral list can help connect patients with linkage venues that meet their needs including both treatment for a positive diagnosis as well as support for other wrap around services. For emergency departments struggling with confirmatory testing or linkage to care, developing in-hospital, public health department or specialty clinic partnerships can help bridge the gap to care. Building strong relationships with other medical and social service organizations in your community will help connect patients with linkage venues that meet their needs including both treatment for a positive HIV, STIs and viral hepatitis diagnosis as well as support for other wrap around services.

Related resources

• Partnership Mapping Template (PDF): This template provides a framework to help your organization keep track of relationships with local community health centers and other non-clinical services that will support a sustainable linkage to care program.
• Tool for Tracking Partners and Partnership Activities: Pages 81-88 from HRSA’s Integrating HIV Care, Treatment & Prevention Services into Primary Care – A Toolkit for Health Centers guide includes a Partnership Toolkit that provides a comprehensive list of key considerations, steps, and Partnership-Focused Templates to help guide organizations’ relationship building and tracking.
• Health Department directories: This resource from the CDC outlines who is working to protect the public’s health in your area, including senior health officials, state, local, and territorial health departments, and tribes and Indian organizations. Clinical staff may need to develop relationships with staff in various sections of health departments in order to facilitate reporting, linkage to care or prevention, and other critical services.
• Clinical Guidance for PrEP: This resource from the CDC outlines recommendations, treatment options and considerations for managing patients on PrEP.
• Preventing new HIV Infections: This webpage from the CDC includes both the latest Clinical Practice Guidelines and Clinical Providers’ Supplement for using PrEP for the prevention of HIV infection.
• National HIV PrEP Curriculum: This free resource was developed at the University of Washington for health care professionals who want to learn about HIV PrEP.
• CDC Guidelines on the use of doxy PEP: This report outlines CDC’s recommendation for the use of doxycycline postexposure prophylaxis (doxy PEP) for bacterial sexually transmitted infection prevention.

2. Hire or assign current staff as patient navigators

Emergency departments primarily serve vulnerable populations, who may be facing a host of non-clinical challenges in addition to a positive diagnosis. Patient navigators take on the labor-intensive responsibility of delivering patient education following a positive diagnosis, making multiple follow-up calls and arranging treatment appointments so health care professionals can focus on clinical duties.

Related resources

• HIV Navigation Services Section of the Rapid Antiretroviral Therapy Toolkit: Section 2 (beginning on page 19) of this toolkit developed in partnership by Primary Care Development Corporation, My Brother’s Keeper, the San Francisco Community Health Center, and the Denver Prevention Training Center provides an overview of the essential role of HIV navigation services in rapid ART services. It also includes a review of staffing needs and considerations for resource-limited settings, suggested protocols, and real-world examples of how to provide services in resource variable settings.

Form a strong referral network 

Alex McIntosh-Ogunfolu from CCI Health Services discusses the importance of building strong community partnerships in order to create a warm handoff for patients seeking treatment or additional services following a visit in the ED

Hire or assign current staff as patient navigators

Lesley Miller, MD, reviews the pros and cons of two different approaches to patient navigation that the Grady Liver Clinic has employed after a positive diagnosis in the Grady Memorial Hopsital ED—bedside navigation and traditional navigation

Carmen Burrell, DO, describes how West Virginia University approaches linking patients to care after a positive diagnosis in the emergency department

The toolkit is organized across the screening continuum and offers helpful resources and best practices for the emergency department care team.

Step 1: Patient triage

Step 2: Initiating standard screening protocols

Step 3: Testing and diagnosis

Step 4: Education and post-test counseling

Step 5: Linkage to care

Resource library

Disclaimer: This page contains resources supplied by third party organizations. Inclusion of these materials on this page does not imply endorsement of these resources or corresponding organization.