I hope everybody had a restful and relaxful Labor Day. Today's POTD comes straight from the horses mouth, AKA our fearless admin leader REUBEN "I'M NOT THE GUY FROM CASH CAB " STRAYER.
He posed a question to me. "Josh, I want to diagnose more people with HIV in our ER, how would I go about doing it???"
Well thankfully for Reuben, and all our new HIV positive folks, we as doctors can order the screening test in HMED. It used to be controlled by nursing, but now we have the power. FIRST, lets talk about how to order it.
-Go into PHYSICIAN tab --> CDS forms --> HIV testing (it's ~10th on the list, just below EBOLA screening). From there it's just a single button in the HIV testing page.
NOW lets talk about what the hell you're ordering. It comes up as "HIV AB, HIV 1/2, EIA, WITH RFLX". HUH???
So, what this means.
1. The first test that the blood is run through is a HIV 1/2 antibody test with ELISA (enzyme-linked immunosorbent assay, or EIA as in the order). This is a quick test, where they dilute the serum and apply it to a plate with HIV antigens attached. If it sticks, it's positive (it's more complicated than just PRESTO, but for our simple ER minds I'll leave it at that). Sensitivity AND Specificity of this assay are >99% according to multiple studies. However the RFLX at the end of the order means that if it's positive, they will reflexively do a western blot to confirm.
-The ELISA is ready fast, a few hours at the most.
2. Western Blot. That's the fancy thing with gel electrophoresis and stuff. Who cares. It's pretty good. They will run it only if the EIA is positive. And if you positive you positive dawg.
-This can take days. Patient needs to be given good follow-up and someone to follow up this blot.
Now go out there and diagnose some people with HIV!