Yan Diana Hou, Jeon Avery, Ng Yunfai, Rivera Alexa, Donnelly Lauren, Baker Lorien, Zisu Manuela P, Lim Czer Anthoney
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
School of General Studies, Columbia University, New York, NY, USA.
J Autism Dev Disord. 2024 Dec 19. doi: 10.1007/s10803-024-06690-y.
Children and adolescents are experiencing a mental health crisis. Neurodiverse patients have high rates of mental health conditions and worse outcomes. To address this disparity, the Autism Spectrum Disorder Care Pathway was applied to a pediatric emergency department (PED) and Observation Unit (OU) in order to decrease agitation experienced by these patients.
This prospective cohort study was in a community-based PED and OU from June 2023 to February 2024. A medical education curriculum consisting of a multidisciplinary champion training and toolkit rollout was completed. Agitation was measured by the Behavioral Activity Rating Scale. The primary aim was to decrease frequency of agitation experienced by neurodiverse patients at any point in the PED/OU. The secondary outcome was to decrease pharmacologic intervention and physical restraint use.
We captured data from a total of 45 patients, with 19 baseline patients and 26 patients in the intervention group. At baseline, 9 out of 19 (47%) patients experienced agitation at some point in their PED/OU stay. After implementation of the curriculum, agitation levels decreased to 6 out of 26 (23%) patients (p = 0.04). Inter-rater reliability was 0.95. There were 3 incidences of pharmacologic intervention and no physical restraint use.
This pilot medical education curriculum for PED and OU staff members decreased agitation in neurodiverse patients who presented for mental health complaints. This study is the foundation for expansion of the curriculum for use in general emergency departments.
儿童和青少年正经历心理健康危机。神经多样性患者心理健康问题发生率高且预后较差。为解决这一差异，将自闭症谱系障碍护理路径应用于儿科急诊科（PED）和观察单元（OU），以减少这些患者的躁动。
这项前瞻性队列研究于2023年6月至2024年2月在一个社区儿科急诊科和观察单元进行。完成了一个由多学科冠军培训和工具包推广组成的医学教育课程。通过行为活动评分量表测量躁动情况。主要目的是降低神经多样性患者在儿科急诊科/观察单元任何时间点经历的躁动频率。次要结果是减少药物干预和身体约束的使用。
我们共收集了45例患者的数据，其中19例为基线患者，26例为干预组患者。基线时，19例患者中有9例（47%）在儿科急诊科/观察单元停留期间的某个时间点出现躁动。课程实施后，躁动水平降至26例患者中的6例（23%）（p = 0.04）。评分者间信度为0.95。有3次药物干预事件，未使用身体约束。
这项针对儿科急诊科和观察单元工作人员的试点医学教育课程降低了因心理健康问题前来就诊的神经多样性患者的躁动。本研究是扩大该课程在普通急诊科应用的基础。
