Improving the Care of Transgender/Gender-Nonconforming Patients in the Emergency Department Through Quality Improvement: An Educational Intervention for Emergency Clinicians

Abstract

Background

There is a significant gap in the provision of care for transgender or gender-nonconforming patients. This population experiences a multitude of disparate health outcomes. Studies have demonstrated a clear knowledge gap among ED clinicians regarding the care for transgender or gender-nonconforming patients.

Context

A significant number of ED clinicians reported caring for transgender or gender-nonconforming patients during their careers. Currently, many ED clinicians report receiving minimal or no training in the care of transgender or gender-nonconforming patients. This lack of competency contributes to ED care avoidance in this population.

Methods

This quality improvement project aimed to evaluate the effectiveness of improving clinicians’ knowledge and skills, openness and support, and oppression awareness in transgender or gender-nonconforming patients through a targeted educational intervention. This study included 4 community hospital-based emergency departments. Performance in the domains of knowledge and skill, openness and support, and oppression awareness was measured using the Ally Identity Measure questionnaire and a paired t test analysis of scored results.

Intervention

The intervention for this quality improvement project was a synchronous, in-person education session delivered once in each of the respective hospital-based emergency departments that addressed key components of understanding transgender or gender-nonconforming patient care. These topics include relevant terminology, assessment recommendations, common gender-affirming therapies, and local resources for follow-up. It also incorporated audio/video testimonies of transgender or gender-nonconforming patients and a case study.

Results

Improvement was demonstrated in all 3 domains when comparing the pre- and postintervention Ally Identity Measure scores. Knowledge and skills demonstrated the most significant increase from pre- (mean, 25.3) to postintervention (mean, 34.6). Openness and support and oppression awareness demonstrated almost equal improvement when comparing pre- (openness and support mean, 27.0; oppression awareness mean, 16.9) and postintervention performance (openness and support mean, 29.2; oppression awareness mean, 18.4).

Conclusion

Transgender or gender-nonconforming patients represent a unique clinical cohort that requires specialized knowledge to provide competent patient care. ED clinicians demonstrated knowledge deficits regarding transgender or gender-nonconforming patient care. These findings support the need for formalized training in the care of transgender or gender-nonconforming patients and its effectiveness in addressing the existing ED clinician education gap.