Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders

Area of Science:

• Pediatric Emergency Medicine
• Neurodevelopmental Disorders
• Healthcare Quality Improvement

Background:

• Emergency departments (EDs) face challenges in providing optimal care for children with autism spectrum disorder (ASD).
• Objective measures are needed to assess care delivery for pediatric patients with ASD in ED settings.

Purpose of the Study:

• To develop and validate a method for objectively assessing the quality of care delivered to children with autism spectrum disorder (ASD) in the emergency department (ED).
• To quantify the difficulties encountered by children with ASD during ED visits using a novel metric.

Main Methods:

• A case-control study involving patients aged 2 to 18 years, comparing children with ASD (cases) to neurotypical controls.
• Development of a Task Completion Index (TCI) to measure the ability to complete essential ED tasks.
• Matching of cases and controls 1:1 based on hospital admission records from January 2016 to January 2018.

Main Results:

• Children with ASD exhibited significantly higher median TCIs (0.25) compared to neurotypical controls (0; p < 0.01).
• Patients with ASD were more likely to experience difficulties with triage vitals (5x), require additional staff for IV placement (3x), and face care plan delays (4x).
• Higher TCIs were associated with an 8-fold increased likelihood of requiring pharmacologic or physical restraint.

Conclusions:

• The Task Completion Index (TCI) effectively captures difficulties in accomplishing core ED tasks for children with ASD.
• Children with ASD are at a higher risk for care disruptions in the ED, as indicated by elevated TCIs.
• Future quality improvement initiatives for pediatric ASD care in EDs should prioritize effective care administration alongside patient experience metrics.