Improving the care of children with autism and related neurodevelopmental disorders in emergency department settings: Understanding the knowledge-to-practice continuum of emergency department providers.

Objectives: Emergency department (ED) healthcare providers (HCPs) frequently describe a lack of knowledge in caring for children with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). Our primary objective is to explore gaps in training and clinical exposure reported by ED HCPs caring for children with ASD/NDD. Methods: A two-phase, mixed-methods cross-sectional study was conducted. In phase 1, an interprofessional sample of tertiary care paediatric ED HCPs (physicians, nurses, social workers, and child life specialists) were surveyed about their experiences and perceived gaps in managing children with ASD/NDD. These responses informed phase 2, where six semi-structured interviews were conducted. Interview transcripts were analyzed to determine themes around the discomfort of ED HCPs caring for children with ASD/NDD. Results: The majority, 54/78 (69%) of eligible staff completed the survey. A minority (42.5%) of HCPs had mandatory training on ASD/NDD, and 80% would value continuing education. Some ED HCPs (41.2%) had previous personal or professional experiences with children with ASD/NDD that facilitated deeper empathy and awareness of system challenges. Interviews revealed four themes of ED HCP discomfort with this population: 1) added considerations of interacting with children and families with ASD/NDD; 2) the ED as a single touch point in complex and limited healthcare systems; 3) recognizing comfort in discomfort; and 4) the need to implement practical interventions to improve care. Conclusions: ED HCPs are motivated to improve care for children with ASD/NDD. Alongside broader systems interventions, future educational interventions can narrow ED HCP gaps identified through this work.