Introduction: In 2019 the United States Preventive Services Task Force (USPSTF) released draft guidelines recommending universal hepatitis C virus (HCV) screening for individuals aged 18-79. We aimed to assess the efficacy of an Emergency Department-based HCV screening program, by comparing screening practices before and after its implementation.Methods: We performed a retrospective cohort analysis of two temporally-matched, 11-month study periods, corresponding to before and after the implementation of a best practice advisory (BPA). Patients were screened for anti-HCV antibody (Ab) and positive results were followed by HCV viral load (VL) testing. The primary implementation outcome was ED testing volume (number of tests performed/month). The primary screening outcomes were the seroprevalence of anti-HCV Ab and HCV VL. Data were described with simple descriptive statistics.Results: The median age of patients was similar between periods (pre: 50 years [IQR 34-62], post: 47 years [IQR 33-59]). Patients screened were more likely to be males in the pre-BPA period (Male, pre:60%, post: 49%). During the pre-BPA study period, a total of 69,604 patients were seen in the ED, and 218 unique patients were screened for HCV (mean 19.8 tests/month). During the post-BPA study period, a total of 68,225 patients were seen in the ED, and 14, 981 unique patients were screened for HCV (mean 1,361.9 tests/month). Anti-HCV Ab seroprevalence was 23% (51/218) and 9% (1,340/14,981) in the pre-BPA and post-BPA periods, respectively. In the pre-BPA period, six patients with a positive anti-HCV Ab level had follow-up viral load testing (three were detectable). In the post-BPA period, reflex VL testing was performed in most patients (91%, 1,225/1,340), and there were 563 patients with detectable VLs.Conclusion: Our study shows that utilizing a universal BPA-driven screening protocol can dramatically increase the number of patients screened for HCV and increase the number of new HCV diagnoses.