Emergency department care experiences among 2SLGBTQQIA+ patients: a mixed methods study

Background: Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do not identify with an equity-deserving group in Kingston, Canada, ultimately aiming to enhance inclusivity and better meet healthcare needs.

Methods: Data were collected through a mixed qualitative/quantitative cross-sectional study using a novel electronic survey tool (Spryng.io), which purposely integrates qualitative and quantitative data, while minimising researcher bias. A community-based participatory approach was employed to involve community stakeholders. Participants were recruited from the Kingston Health Sciences Centre's ED, Urgent Care Centre, and at community-based organisations. Quantitative data were analysed using chi-squared tests, while qualitative data underwent thematic analysis. Results were triangulated. Focus group discussions with community partners were then undertaken to contextualise findings.

Results: Compared to persons who did not identify as belonging to an EDG (n = 949), 2SLGBTQQIA+ individuals (n = 118) felt their identity had a more negative impact on their care (p < 0.0001) and experienced more judgment and disrespect from healthcare providers (HCPs) (p < 0.0001). Four themes emerged from triangulation of qualitative and quantitative data: (1) mixed emotions regarding ED care; (2) transgender and non-binary health care considerations; (3) unmet mental health needs; and (4) lack of patient-centred care for 2SLGBTQQIA+ patients.

Conclusions: 2SLGBTQQIA+ individuals often face unmet mental health care needs, requiring tailored mental health care provision in the ED. Intersectionality within the 2SLGBTQQIA+ population underscores the importance of trauma-informed care. Strategies to improve 2SLGBTQQIA+ healthcare include implementing safer spaces, clear feedback mechanisms, referrals to gender-affirming specialists, and privacy in triage. Further research should assess the impact of educational interventions on HCP knowledge and patient experiences in the ED.