6613 ‘See me ASD’: improving the experience and safety of autistic children in the paediatric emergency department

Objectives The prevalence of autism in England is approximately 3%.1 Autistic children are more likely to experience medical comorbidities requiring hospital presentation than the general population.2 Distress due to unmet behavioural and sensory needs can make them difficult to assess and manage safely. Yet paediatric emergency department (PED) staff receive little training or resources to help minimise distress and manage them safely. Serious incidents reported in the media have highlighted the importance of accurate and timely assessment by trained medical professionals to improve outcomes for these vulnerable children.3 We aimed to improve care for children with autism in our PED department at a district general hospital in London. Specifically, our objectives were: 80% of parents of autistic children reporting experiential satisfaction and perceived patient safety by November 2023. 100% of PED staff reporting confidence in assessing and managing autistic children by November 2023. Methods A multidisciplinary team, including a parent of an autistic child, reviewed current guidelines, pathways and patient experiences of attending PED. They co-produced Quality improvement (QI) interventions and Plan-Do-Study-Act (PDSA) cycles. Cycle 1: Triage nursing staff encouraged to explore with parents the child's needs and act on them Cycle 2: Environmental adaptations: distraction boxes, cubicle space, visual aids Cycle 3: Environmental adaptations optimised Cycle 4: Autism specific simulation training for PED staff Parents of autistic children were continuously surveyed pre- and post-intervention using QR codes in PED. PED Staff were surveyed at baseline and then weekly post interventions. 3-point Likert scales and qualitative thematic analysis was used for both surveys. Results Graph 1 shows all parental survey responses collected over three months. After cycle 1, parental perceived patient safety increased from 1/5(20%) to 5/5(100%). Satisfaction increased from 2/5(40%) parents to 4/5(80%). Staff actively exploring a child's needs with parents was particularly effective. The proportion of surveyed staff reporting exploring a child's needs with parents increased from 2/7(28%) to 6/9(66.6%). Post-intervention, 4/5(80%) parents felt listened to about their child's needs, and that adaptations were made. Graph 2 shows PED staff survey results. Staff reporting 'no confidence' to assess and manage autistic children dropped from 3/18(16%) to 0/16(0%). Most staff reported 'neutral' confidence post-intervention. Conclusion Our data suggests a multi-disciplinary and co-produced QI can improve the experience and safety of autistic children in PED. Staff exploring sensory/behavioural needs with parents was the most effective intervention. We are continuing measurement monthly to ensure sustainability and are disseminating our findings. References O'Nions E, et. al. Lancet Reg Health Eur, 2023. Al-Beltagi M. World J Clin Pediatr, 2021. Ruth Clegg, et al. BBC, 2023.