Effect of Routine Opt-Out HIV Screening on Emergency Department Operational Metrics: Results From the Pragmatic Randomized HIV TESTED Trial

Comprehensive Summary

In their study, Jones et al. (2025) examined the effects of emergency department (ED) HIV screening on patient throughput, including measures of patient wait times and length of stay for admitted patients. Using patient data from 4 major hospitals across the U.S from 2014-2016, Jones et al. analyzed patient encounter information and determined HIV screening’s correlation with patient throughput metrics. Through their study of over 377,000 patients, 13,000 of which completed screening, Jones et al. found most significantly that HIV screening led to an average of a 1.4 minute greater waiting time. They additionally identified a 16.8 minute shorter length of stay in admitted patients, a 16.2 minute less door-to-door time, and a 10% higher likelihood of patients leaving before completion of treatment. No significant correlation between HIV screening and length of stay for non admitted patients was found. Overall the study was able to conclude that while HIV screening led to a slightly increased waiting time (1.4 minutes) and a 10% increase in patients leaving before conclusion of treatment, these effects are likely clinically negligible in terms of patient outcome.

Outcomes and Implications

An estimated 150,000 individuals in the U.S are living with HIV that is undiagnosed, contributing to 31,800 transmissions that occur annually. Due to the amount of new cases each year, routine screening of individuals in the emergency department is an important tool that can identify individuals unknowingly living with the disease, also reducing onward transmission. These findings address concerns surrounding HIV testing in the ED, by displaying that HIV testing has little effect on patient throughput and seeks to benefit vulnerable patient populations. By better understanding the effect (or lack thereof) of HIV testing in the ED, screening can become more widespread, helping to lower the rates of transmission and help reduce transmission and prevent new infections.