Implementation of an alert system for the care cascade of Hepatitis C infection in patients undergoing elective surgery

Abstract

Background: A key barrier to an effective care cascade for Hepatitis C virus (HCV) is limited awareness, especially among patients undergoing elective surgery. To address this issue, we introduced an electronic medical record (EMR)-based automatic alert system in 2021 to enhance surgical healthcare providers&apos; awareness of HCV screening and referral rates. Methods: The alert system was designed to alert surgeons to order preoperative HCV antibody testing for patients undergoing elective surgery before admission and, at discharge, recommend hepatology consultation for patients with positive HCV antibody testing. Results: The system significantly improved the HCV screening rate by 73,834 (96.8 %) among 76,310 patients undergoing surgery after system implementation, compared to 106,854 (82.8 %) among 129,065 patients between 2016 and 2020 (P < 0.001). Among them, the system alerted 12,048 (16.3 %) cases, and 463 patients tested positive for HCV antibodies. However, only 42 (15.3 %) were referred out of 275 (59.4 %) who required hepatology consultation. Linkage failure was associated with other surgery departments than hepatobiliary and transplant surgery departments (odds ratio [OR]=5.940, 95 % confidence interval [CI], 3.080-12.410, P < 0.001) and shorter hospitalization duration (OR=0.980, 95 % CI, 0.950-0.990, P = 0.012). Conclusion: The EMR-based automatic alert system effectively increased HCV screening for patients undergoing elective surgery before admission. However, it could not link them to care cascade in surgery departments. Combining more proactive approaches would be beneficial, such as reflex testing or a callback strategy. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).