P121: Understanding health equity: a pilot project to collect socio-demographic information on emergency department patients at registration

Abstract

Introduction: There is strong evidence that socio-economic factors such as income, housing and ethnicity are linked to health outcome disparities for emergency department (ED) patients. However, lack of real-time patient data has limited our ability to identify, understand and address health disparities. During a 14-week period, we assessed the feasibility and acceptability of the systematic collection of patient-level equity data in a busy tertiary care urban ED. Methods: We assessed feasibility by directly observing impact on registration time, percentage of patients on which data was collected, and ambulance patient data collection. We also assessed acceptability to patients, registration staff and clinicians through structured interviews of patients systematically sampled, focus group and surveys of registration staff and survey of clinicians. Results: Over the course of the study, equity data was collected on 2017 patients. Capture rate peaked in week 7 with 51% of eligible patients offered the equity questions and 30% answering. Average patient registration time increased from 215 seconds to 345 seconds (60%). Data collection with ambulance patients did not appear feasible. Patients (n=30) reported being comfortable with most questions except income (47% comfortable). 93% believed it could improve health services. However, a small number of patients voiced concern that the data could result in discrimination. Registration staff required sustained support and engagement, but some continued to feel uncomfortable with offering the questionnaire to some patients. Conclusion: Large scale collection of equity data is feasible but requires additional resources and sustained staff and patient support. Patient participation rate is likely to remain relatively low and is likely to underestimate disadvantaged groups. Data collection at multiple points within an institution may improve capture rate.