# Development of a Quality Measure to Improve HIV and Syphilis Screening in the Emergency Department: A Modified Delphi Approach

## TL;DR

This paper describes creating a quality measure to improve HIV and syphilis screening in emergency departments by co-screening with other tests.

## Contribution

The novel contribution is a new quality measure for co-screening HIV with other STI tests in EDs using a modified Delphi approach.

## Key findings

- Co-screening for HIV with other STI tests was identified as the most impactful and feasible approach.
- A quality measure was successfully developed to improve screening rates in emergency departments.
- The approach aligns with balancing health impact and feasibility in healthcare settings.

## Abstract

Emergency department (ED) screening is an important strategy to address the persistent human immunodefiency virus (HIV) epidemic; however, ED screening rates remain low. This study describes the development of a quality measure to improve screening rates for HIV among ED patients. A panel of 10 emergency physicians with expertise in ED-based preventive health and quality measurement employed a 3-round modified Delphi process. The panel reviewed peer-reviewed literature and national guidelines to identify high-risk patient populations; participated in anonymous surveys to rank ED screening approaches based on the impact and feasibility of measurement and practice; and discussed survey rankings in consensus discussions. The highest impact and most feasible group to target for quality measurement were ED patients already undergoing testing for other sexually transmitted infections (ie, “co-screening”). This study successfully designed a quality measure to improve coscreening for HIV in the ED. Implementing this measure could enhance detection and subsequent linkage to care, ultimately contributing to the control of these epidemics. The focus on combining screening for HIV with diagnostic testing for patients with signs and symptoms of sexually transmitted infection aligns with an emerging approach in health care settings that balances expected health impact with feasibility challenges.