Reduce Emergency Department Wait Times & Improve Care

People on the autism spectrum visit emergency departments far more often than the typical person, and their care is typically inefficient and often ineffective. A trip to the Emergency Department (ED) isn’t fun for anyone, but it can be especially difficult for individuals with Autism Spectrum Disorder (ASD).

  • “Emergency Room clinicians are trained in the management of aggressive and disruptive behavior in typically developing children, but they may not be familiar with how to manage a child with autism who has severe behavior problems,” says Roma Vasa, a senior author and child psychiatrist in Kennedy Krieger Institute’s Center for Autism and Related Disorders. “Caring for that child is different because of his or her language, social, learning and sensory problems. Moreover, many children with autism have anxiety about medical procedures. Collectively, these challenges can make the ER experience overwhelming and potentially traumatic for a child with autism.”

Autism is a spectrum disorder that consists of a wide range of conditions that can vary greatly based on the individual impacted. These conditions often relate to challenges related to social skills, repetitive behaviors, speech and nonverbal communication.

Despite these challenges, those with autism have been shown to frequent the ER more often than those who are not on the spectrum. Children with ASD visit the emergency department 30 percent more than children without ASD while teens between 15 to 18 years old with ASD visit 70 percent more. Adults with autism frequent the ED twice as often as adults without autism.

The emergency department is a place that, for many, can cause stress and anxiety. Those with autism may experience this on an even deeper level as they are often impacted more intensely by their surroundings than neurotypical people. Unfortunately, ED staff is typically not trained to understand how to work with individuals with ASD and language and learning challenges can make it difficult when trying to understand hospital procedures and medical tests.

Long Emergency Department Wait Times can Lead to Ineffective Care

The average wait time in the emergency department is more than 90 minutes before the patient is taken to a room for initial assessment and over two hours before most patients are discharged. While that is a long time for anyone with a pressing issue, when that person has something wrong with them and is constantly getting their senses overwhelmed throughout the process it can seem like much longer.

Patients arriving to the ED with broken bones can typically wait almost one hour before receiving any pain medication and the number of people leaving the ER before even being seen has doubled recently.

So why are ED wait times so long?

Contrary to popular belief, wait times don’t usually occur due to insufficient capacity or lack of funds. ED visits run at an average charge of $1,900 for outpatient visits and $13,198 for admitted patients.

Long waits at the ED are actually a result of variability and because they do not use their funds effectively to reduce wait times, patients suffer. Of course, some waiting is inevitable, but the natural unpredictability of emergency services is the culprit for unnecessarily long wait times.

Emergencies are not planned and therefore it is impossible to know how many people will walk into the ER and when they will arrive. If a large group shows up at the same time, certain people will be obligated to wait, even if the ED is fully staffed. It is impossible to predict the exact staffing needs because each patient requires unique treatment. For example, someone might need a few quick stitches and be on their way, while a more complex patient might require testing in order to reach a diagnosis.

Patients with autism will naturally require a higher level of care and clearer communication than those who are not on the spectrum. Unfortunately, many EDs are not equipped or trained to properly accommodate these individuals.

By placing a focus on improving patient communication and care for those with autism, EDs have the opportunity to not only enhance the patient experience, but to also reduce their wait times due to operating more efficiently.

busy erIncreasing Care for Those Who Need it Most

The lack of proper care for those with autism in the ED is unfortunate, but very prevalent.

Many patients evaluate the quality of their emergency department experience not simply on the clinical processes carried out, but on how they were treated and how their interactions with the staff made them feel. It cannot be stressed enough how important customer service is in order to help patients, especially those on the spectrum, to feel safe, cared for, and understood.

The more that customer service can become part of the healthcare job description, the better, as this will help make the skill of caring for humans equally as important as any clinical skill. To add to this, individuals with autism can struggle when it comes to communicating their needs to nurses and doctors. When ED staff isn’t trained to handle these situations, it can leave the patient feeling helpless and not able to receive the care they need.

Lisa Croen, the director of the Autism Research Program at Kaiser Permanente, comments, “A lot of adults with autism feel lost. It’d be great if physicians had some more general training and awareness. Just like with any other condition, they really have to take into account that particular person in their office and adjust what they’re doing to meet the needs of that patient.”

More than half of adults with autism are also diagnosed with other conditions including diabetes, high blood pressure, heart disease, obesity, autoimmune diseases, hearing impairment, sleep disorders, gastrointestinal problems, schizophrenia, depression, and attention deficit hyperactivity disorder. It takes a team of trained professionals to effectively move someone on the spectrum through the ED system while maintaining a high-level of care and comfort.

The inherent link that exists between confident, engaged staff and patient satisfaction cannot be ignored. It has also been discovered that a team-oriented approach is not only helpful in reducing ED wait times, but also increases staff satisfaction. It is important for each staff member to be on board with operating as a team in order to serve autism patients more effectively.

Poor Patient Flow/Overcrowding can be Especially Problematic

Another challenge for individuals with autism when they visit the ED is that excessive wait times can result in poor patient flow and overcrowding. This isn’t fun for anyone, but can be especially straining on those with ASD causing them to feel anxious and panicked. Crowding of waiting rooms and slow investigation turnaround times along with delays in making decisions related to disposition can all negatively impact patients on the spectrum and can all be reduced through proper care.

It has also been found that there is an association between increased mortality rates within the ED and crowding, which indicates that crowding should be treated as a significant public health concern.

By improving care in the ED for those with autism, they will not only receive better treatment from a team that understands them, but this will cut down on excessive wait room times for all patients as they will be able to move through the system more efficiently and receive the help they need quickly.

Communication Can Make all the Difference in the ED

Another key component to cutting down wait times while enhancing ED care for individuals with autism is focusing on patient communication.

A properly trained staff makes it much simpler to ensure that every team member is on the same page and understands how to work with someone on the spectrum. This includes how to communicate effectively with them in order to reach a positive outcome and be able to provide them with the care they need.

One of the most important parts of communication in the ED is conveying to the patient that they can trust you and that they are in good hands. Patients want to be involved in the healthcare decision-making process and want to feel like they know what’s going on and what will happen next. Patients who participate in decision-making are typically healthier and see better results in the ED.

  • In the Becker’s Hospital Review, Rick J. McCraw and Beth Fuller write, “Trust in a healer is sacred, and frequently the prerequisite for seeking care and the reason for returning to a particular provider, hospital, or health system. Healthcare leaders should promote and recognize this in their clinical practice, and remind staff why they chose to pursue a career into healthcare in the first place: to help and make a difference in the lives of others. By creating an environment that empowers employees to make a difference, healthcare leaders can influence trust and positive staff behaviors; ultimately winning the hearts and minds of care providers for long-term, engaged care interactions.“

Encouraging an environment that fosters transparent communication between patient and care provider is crucial for making patients with autism feel safe, which can reduce the amount of time staff might otherwise spend trying to soothe them, often getting frustrated and making little progress.

In a systematic review of patient experience of adult emergency medicine patients, Justin Morgenstern shares that patients are most concerned with two components relating to communication: interpersonal connection and information.

Patients in the ED want to feel that their clinician is listening to them and genuinely cares for their well-being. Staff can be conscious of maintaining eye contact and using a calm tone of voice to help decrease anxiety. Patients also want to understand what is happening, which can be especially difficult when it comes to patients with sensory deficits. It is important for clinicians to use clear language while eliminating jargon and unnecessary medical terms.

Individuals on the spectrum can also be soothed with regular check-ins and by knowing what to expect. Clearly communicating from the beginning which tests they will undergo, what the staff is looking for, how long the results will take, and answering any of their questions can be helpful.

Placing an emphasis on improving care and communication in the ED for patients with autism is a beneficial way to streamline business operations while making patients feel comfortable and understood. In turn, this allows them to be treated more efficiently and can greatly reduce emergency department wait times.

Learn more about becoming a Certified Autism Center here.

Learn More About Becoming a Certified Autism Center™

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