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

Background: 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. Methods: 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)). Findings: 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 < 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). Conclusions: 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.