The HIV-testing policies of US hospitals

Concern about possible exposure of hospital staff to HIV-infected patients has recently increased, leading to a situation of potential conflict between staff members' need to know whether patients are infected, and patients' rights to confidentiality. To learn more regarding HIV-testing policies in acute-care hospitals, a random sample of 561 private and public hospitals was studied. The chief administrator of each facility received a letter explaining the study, followed some time later by a 15-minute telephone interview. The questions concerned the hospital's history with respect to the admission of AIDS patients, its HIV-testing policies, and the origin of those policies. Results showed that 83 percent of the institutions had admitted at least one patient with AIDS. Fewer than 10 percent had admitted more than 20 AIDS patients during 1988. Slightly more than 83 percent of the hospitals had a written HIV-testing policy, and the factor that had been most influential in developing such a policy was staff members' fear of being infected. A detailed presentation of the elements of the hospitals' testing policies appears. Many (78 percent) required that the patient's informed consent be obtained before testing for HIV; however, notification of the patient in the event of a positive result was required in only three out of four hospitals. Half the hospitals required that test results be placed in patients' charts, to "protect" insurers. Certain policies, such as review of treatment plans for HIV-positive patients, could result in substitution of a less dangerous for a more dangerous procedure; more administrators said such reviews were commonly made because of staff fears of infection (25 percent) than because of potential benefit to the patient (23 percent). Balancing patients' rights against the rights of health care providers is not an easy task for institutions in the face of the AIDS epidemic. (Consumer Summary produced by Reliance Medical Information, Inc.)