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Aims and Objectives Emergency departments (EDs) play a pivotal role in public health by identifying undiagnosed blood-borne viruses (BBVs). Since 2017, NICE and NHS England have recommended routine HIV testing for all patients aged 16-59 attending EDs in areas with high HIV prevalence. South London has among the highest HIV rates in the UK, with boroughs served by St George’s Hospital showing an estimated prevalence of 5.4 per 1,000 population (DHSC 2021); hepatitis B and C are also prevalent. St George’s has operated an opt-out BBV testing pathway since 2018 in alignment with this guidance. Early detection through routine testing enables prompt treatment, reduces transmission, and addresses health inequalities. Despite this, compliance in early 2025 fell to approximately 75%, leaving many patients unscreened. This study aimed to identify barriers and implement interventions to restore and improve testing, demonstrating how ED-led initiatives can have a meaningful public-health impact.Method and Design Quality-improvement (QI) methodology, baseline data analysis, staff surveys, and process mapping identified low awareness of the standard operating procedure (SOP), label-printing errors, and sample under-filling as key barriers. Two Plan-Do-Study-Act (PDSA) cycles were implemented from April to October 2025. Interventions included targeted staff education during teaching and induction sessions, electronic reminders, removal of problematic test-order pathways, and the Just Take Two awareness campaign (encouraging collection of an additional blood tube).Abstract 4211 Figure 1Results and Conclusion BBV testing uptake increased from 75% to 82%, with fewer rejected samples and improved staff confidence. Limitations include difficulty in gaining reliable data, which may have led to underestimation of true compliance. Nonetheless, focused QI initiatives can enhance adherence to mandated BBV testing standards in the ED, supporting early diagnosis, timely treatment, and improved public-health outcomes. Sustained monitoring and education remain essential to maintain gains and ensure equitable access for all patient groups.