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. 2022 Nov 1;12(11):995-1001.
doi: 10.1542/hpeds.2022-006818.

Increasing Frequency of Affirmed Name and Pronoun Documentation in a Pediatric Emergency Department

Gina M Sequeira #  1   2 , Kacie M Kidd #  3 , Caitlin Thornburgh  2 , Alexandra Ley  4 , Darci Sciulli  4 , Megan Clapp  4 , Raymond Pitetti  4   5 , Loreta Matheo  4   5 , Heather Womeldorff  4 , Dimitri A Christakis  1   2 , Noel S Zuckerbraun  4   5
Affiliations

Increasing Frequency of Affirmed Name and Pronoun Documentation in a Pediatric Emergency Department

Gina M Sequeira et al. Hosp Pediatr. .

Abstract

Background and objectives: In a previous study of 204 transgender and gender diverse youth in our region, 44% reported being made to feel uncomfortable in the emergency department (ED) because of their gender identity. The objective of our study was to conduct a 2 year quality improvement project to increase affirmed name and pronoun documentation in the pediatric ED.

Methods: Using process mapping, we identified 5 key drivers and change ideas. The key driver diagram was updated as interventions were implemented over 3 Plan-Do-Study-Act cycles. Our primary outcome, the percentage of ED visits per month with pronouns documented, was plotted on a run chart with the goal of seeing a 50% increase in form completion from a baseline median of ∼14% over the 2 year study period.

Results: The frequency of pronoun documentation increased from a baseline median of 13.8% to a median of 47.8%. The most significant increase in pronoun documentation occurred in Plan-Do-Study-Act cycle 3, immediately after ED-wide dissemination of a near-miss case and subsequent call for improvement by ED leadership. Roughly 1.7% of all encounters during the study period involved patients whose pronouns were discordant from the sex listed in their electronic health record.

Conclusions: This quality-improvement project increased the frequency of pronoun documentation in the ED. This has the potential to improve the quality of care provided to transgender and gender diverse youth in the ED setting and identify patients who may benefit from receiving a referral to a pediatric gender clinic for additional support.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLAIMER: The authors have indicated they have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Key driver diagram.
FIGURE 2
FIGURE 2
Resource page developed for ED providers to support them in delivering gender-affirming care in the pediatric ED. a The QR code linked to the following Web site: https://www.chp.edu/our-services/aya-medicine/gender-development.
FIGURE 3
FIGURE 3
Screenshots of the (a) EHR banner bar that includes affirmed name and pronouns, and (b) questions included to prompt ED providers to ask patients about their name and pronouns during rooming (October 2020 version).
FIGURE 4
FIGURE 4
Run chart showing the percentage of ED visits per month for patients aged >5 years with pronouns documented.
See this image and copyright information in PMC

References

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    1. Sequeira GM, Boyer T, Coulter RWS, Miller E, Kahn NF, Ray KN. Healthcare experiences of gender diverse youth across clinical settings. J Pediatr. 2022; 240:251–255 - PMC - PubMed
    1. Sequeira GM, Kidd K, Coulter RWS, Miller E, Garofalo R, Ray KN. Affirming transgender youths’ names and pronouns in the electronic medical record. JAMA Pediatr. 2020;174(5):501–503 - PMC - PubMed

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