25. Barriers and Facilitators of Proper Gender Identification at Outpatient Surgical Centers Providing Gender-affirming Surgery

OBJECTIVE: Addressing patients with the correct name and pronouns is part of professionalism and common courtesy, and improves trust in the health care system for gender-diverse patients. However, there is little literature evaluating obstacles in this setting to proper identification. We aim to describe baseline data on barriers and facilitators to appropriate name and pronoun use on the day of gender-affirming surgery (GAS) as a step toward quality improvement. METHODS: Administrative, nursing and anesthesia staff providing care for patients who underwent gender-affirming chest surgery at two outpatient surgical centers were administered an online survey. Staff was queried about barriers, facilitators and suggested changes to proper gender identification of patients and tools they use to help prevent misgendering. RESULTS: 120 staff members across two outpatient surgical centers completed this online survey and were included for analysis. Participants primarily worked in the operating room (N=65, 54%) and the post-anesthesia care unit (PACU) (N=38, 32%). Half of respondents (N=59, 49%) believed the rate of misgendering to be 0-25% and respondents identified episodes of misgendering occurring most frequently in the preoperative area (N=58, 48%). The most common barriers to proper patient gender identification were identifying the patient based on their visual appearance alone (N=11, 9%), lack of experience with correct grammar particularly for they/them identifying patients (N=8, 7%), respondent internal bias and “years of conditioning” (N=7, 6%), and patient day of surgery visitor using the incorrect name and pronouns (N=7, 6%). Although most respondents currently use the electronic health record to prevent misgendering (N=76, 63%), common facilitators and suggested changes for misgendering prevention among respondents were to clearly identify name and pronouns visually with items such as a patient badge, color-coded papers in the pre-operative area, and a white board with name and pronouns written. CONCLUSION: Using online surveys of staff at two outpatient surgical centers, we found that visual cues are the most important barriers and facilitators to proper identification of gender-diverse patients. Although the visual cue of patient appearance did trigger internal bias among respondents, many suggested altering the focus of visual cues towards helpful and congruent identifiers would be beneficial. Our next steps include implementing and evaluating suggested visual systematic workflow modifications and creating educational sessions based on other barriers and facilitators. CORRESPONDING AUTHOR: Jessica Hsu, MD, PhD; 7500 Challis Rd, Brighton, MI 48116; [email protected]; (734) 998-6022