Nicholas David B, Zwaigenbaum Lonnie, Muskat Barbara, Craig William R, Newton Amanda S, Cohen-Silver Justine, Sharon Raphael F, Greenblatt Andrea, Kilmer Christopher
Faculty of Social Work, University of Calgary (Edmonton Division), Edmonton, Alberta, Canada;
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
Pediatrics. 2016 Feb;137 Suppl 2:S205-11. doi: 10.1542/peds.2015-2851S.
There is increasing recognition that children with autism spectrum disorder (ASD) experience challenges in busy clinical environments such as the emergency department (ED). ASD may heighten adverse responses to sensory input or transitions, which can impose greater difficulty for a child to cope with situational demands. These problems can be amplified in the ED because of its busy and unpredictable nature, wait times, and bodily care. There is little literature documenting ED-based needs of children with ASD to inform clinical guidelines. The objective was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide ED service delivery for children with ASD.
After qualitative interviews with children, parents, and health care providers conducted in a previous phase of this study, focus groups were convened with parents of children with ASD, ED clinicians, and ED administrators (total n = 60). Qualitative data were analyzed based on an interpretive description approach.
Participants identified the ED and its delivery of care as insufficient to meet the unique needs of children with ASD. The following clinical priorities were identified: ASD-focused preparedness for ED procedures and processes, wait time management, proactive strategies for sedation and restraint, child-focused support, health care provider capacity building, post-ED follow-up resources, and transition planning to adult care. Heightened child- and family-centered care were strongly recommended.
人们越来越认识到，患有自闭症谱系障碍（ASD）的儿童在急诊室（ED）等繁忙的临床环境中会面临挑战。ASD可能会加剧对感官输入或环境转变的不良反应，这会给儿童应对情境需求带来更大困难。由于急诊室繁忙且不可预测的性质、等待时间以及身体护理等因素，这些问题在急诊室可能会被放大。几乎没有文献记录自闭症谱系障碍儿童在急诊室的需求，以指导临床指南。目的是确定利益相关者在确定临床优先事项和建议方面的观点，以指导为自闭症谱系障碍儿童提供急诊服务。
在本研究的前一阶段对儿童、家长和医疗服务提供者进行定性访谈后，召集了自闭症谱系障碍儿童家长、急诊临床医生和急诊管理人员的焦点小组（共60人）。基于解释性描述方法对定性数据进行分析。
参与者认为急诊室及其护理服务不足以满足自闭症谱系障碍儿童的独特需求。确定了以下临床优先事项：针对急诊程序和流程的以ASD为重点的准备工作、等待时间管理、镇静和约束的积极策略、以儿童为中心的支持、医疗服务提供者能力建设、急诊后随访资源以及向成人护理的过渡计划。强烈建议加强以儿童和家庭为中心的护理。
