Caregiver Satisfaction with Emergency Department Care for Pediatric Patients with Neurodevelopmental Disorders

Children with neurodevelopmental disorders (NDDs) often encounter increased adversity when navigating the health care system. In this study, we explored the pediatric emergency department (PED) experience for patients with NDDs and their caregivers compared with that of patients without NDDs.

Data for this study were obtained from National Research Corporation patient experience survey questionnaires and electronic medical record (EMR) data for patients presenting to a PED between May 2018 and September 2019. ED satisfaction was determined by the top-box approach; ED ratings of 9/10 or 10/10 were considered to reflect high ED satisfaction. Demographics, Emergency Severity Index, ED length of stay, time from arrival to triage, time to provider assessment, and diagnoses were extracted from the EMR. Patients with NDDs were identified based on International Classification of Diseases, Tenth Revision codes; patients with intellectual disabilities, pervasive and specific developmental disorders, or attention-deficit/hyperactivity disorders were included in the NDD cohort. One-to-one propensity score matching between patients with and without NDDs was performed, and a multivariable logistic regression model was built on the matched cohort.

Patients with NDDs represented over 7% of survey respondents. Matching was successful for 1162 patients with NDDs (99.5%), resulting in a matched cohort sample size of 2324. Caregivers of patients with NDDs had 25% lower odds of reporting high ED satisfaction (95% confidence interval [CI], 0.62-0.91, p = 0.004).

Caregivers of patients with NDDs make up a significant proportion of survey respondents and are more likely to rate the ED poorly than caregivers of patients without NDDs. This suggests an opportunity for targeted interventions in this population to improve patient care and experience.