6805 An investigation into the difficulties and improvement strategies for emergency department care of children with autism spectrum disorder

Objectives The paediatric emergency department (ED) constitutes a dynamic, sensory-intense setting, which can present inherent challenges in promoting effective person-centred care for children and young people (YP) diagnosed with Autism Spectrum Disorder (ASD). This literature review explores the obstacles and complexities of the ED experience as perceived by children with ASD, their caregivers, and healthcare professionals (HCP), and suggests achievable, effective strategies for improvement. Methods The SPIDER tool¹ was used to produce a research question, to enable a systematic and comprehensive literature search on CINAHL, PyschINFO and Pubmed. To reduce limitations on results, 'snowball sampling' was also used. After application of rigorous inclusion and exclusion criteria, and creation of a PRISMA flow-diagram, 8 articles were identified and critically appraised using McMaster's review form for qualitative studies (version 2.0).² This identified any researcher bias and the presence of an audit trail, and assessed procedural rigour and believability. Results Thematic analysis of the 8 articles uncovered the challenges as: the complicated interplay between characteristics and behaviours of a child with ASD and the ED environment itself; difficulties with long wait times, and conflicts for parents and carers regarding disclosure of their child's needs and diagnosis. Despite this, important improvement strategies were revealed. These comprise adaptations to the ED environment and HCPs approach to care; additional resources; improved wait time management; increased parental involvement, and provision of autism training and education for staff. The feasibility of implementing said strategies is also discussed. Conclusion The findings underscore communication as a central issue for the child, caregiver and professional. The lack of parental disclosure, often stemming from prior negative experiences, coupled with the absence of an autism identification process, results in crucial aspects of a child's characteristics and needs being overlooked. This includes factors such as non-verbal communication, unique pain expression, and sensory sensitivities. Furthermore, the lack of an alternative management pathway and adequate distraction resources can lead to worse patient experience and care. It is therefore recommended that mandatory autism training be introduced, and emergency departments promote the adoption of patient passports and pre-triage autism identification. Furthermore, providing a sensory resource trolley or box can help alleviate the issues surrounding extended waiting times. To consolidate these findings into a practical framework, a new, informed management pathway has been designed (figure 1), that minimizes the necessity for verbal disclosure and endorses achievable adjustments to care and processes, with the hope of transforming the experience of and improving outcomes in emergency department care for children with autism. References Cooke A, Smith D, Booth A. 'Beyond PICO: the SPIDER tool for qualitative evidence synthesis', Qualitative Health Research, 2012;22:1435–1443. Letts L, Wilkins S, Law M, Steward D, Bosch J, Westmorland M. 'Critical Review Form – Qualitative Studies (Version 2.0)', McMaster University. 2007.