Collecting sexual orientation and gender identity information in the emergency department: Patient and provider perspectives from the EQUALITY study

Introduction: Collecting information about sexual orientation and gender identity (SO/GI) during emergency department (ED) admissions would enable investigation of disparities and could enhance patient-centered care. We examined patient, provider, and registrar perspectives and preferences for SO/GI data collection in EDs to inform best practices.   

Methods: Semi-structured interviews conducted 2014-2015 with a diverse purposive sample of heterosexual, lesbian, gay, bisexual, and transgender patients (n=52) and ED nurses, physicians, and registrars (n=35) in a major metropolitan area. Interviews were recorded, transcribed verbatim, and analyzed by multiple coders using constant comparative methods.

Results: A trajectory of the ED care encounter emerged showing key points for collection and SO/GI relevance, with preferences and considerations at each. Comfort and willingness hinged upon data collection purpose (individual medical relevance vs. population health), mode of collection (form-based vs. verbal), privacy protections, interpersonal and environmental cues to safety, and use and flow of information during care encounter. Medical relevance perceptions varied between patients and providers, with greater overall appreciation for GI relevance. Form-based methods were more acceptable across points of care, yet electronic health records posed unique concerns. Participants highlighted that SO/GI information also contextualizes patient relationship/family status and acknowledges LGBT personhood.

Conclusions: Collection of SO/GI in the ED requires attention to patient, provider, and registrar input on methods, operational and institutional aspects, and contexts of data collection and utilization. Ensuring cultural competency, environmental cues to safety, and appropriate use and protections of information will be key considerations as institutions respond to policy recommendations for SO/GI data collection.