WIP 76 - Improving Gender Identity Screening for Hospitalized Adolescents

Publication Number: WIP 76.7434

Katherine B. Tygart, Rady Children's Hospital San Diego, San Diego, CA, United States; Maja Marinkovic, University of California San Diego Medical Center, San Diego, CA, United States; Tiranun Rungvivatjarus, Rady Children's Hospital/UCSD, San Diego, CA, United States; Aarti Patel, UC San Diego, San Diego, CA, United States; Begem Lee, Rady Children's Hospital San Diego, San Diego, CA, United States; Heather Pierce, UCSD/Rady Children's Hospital, San Diego, CA, United States

Background: Acknowledgment of gender identity and access to gender affirmation resources decrease depression and anxiety prevalence and improve overall quality of life for transgender and non-binary youth. A prior quality improvement (QI) project in 2022 at our institution aimed to improve the rate of gender identity screening for adolescent patients admitted to pediatric hospital medicine (PHM). Given the lack of sustained improvement, we plan to reassess screening rates, identify barriers, and implement interventions.

Objective: Using QI methodology, our aim is to improve screening rate for gender identity in patients 12 years and older admitted to PHM by 20% in a 6-month period.

Design/Methods: This single-center project is ongoing at a freestanding children’s hospital. We used electronic medical record (EMR) data to assess the pre-intervention rate of gender identity screening for adolescent patients admitted to PHM from 12/2023 to 06/2024, which was 3% (24/752 patient encounters). The prior screening rate in 2022 was 4%, and a sustained change was not observed after interventions.

Residents, medical students, and nurse practitioners completed Ishikawa diagrams used to identify barriers to screening completion and develop targeted interventions. Reported barriers included time constraints during admissions, privacy concerns, and difficulties documenting in the EMR.

Planned interventions include a gender identity screening prompt within the standardized admission note template, provider trainings on screening and documentation, and EMR optimization of gender identity screening. Transgender or gender-diverse patient resource materials are being developed for distribution by providers. EMR data will be reviewed monthly to assess our outcome measures as part of Plan-Do-Study-Act cycles. Measures include screening completion and resource distribution rates. Balancing measures include confidentiality breach reports and assessments of provider ability to incorporate screening into patient workflow.