Enhancing emergency department care for individuals with autism spectrum disorder across the lifespan: a systematic review
Objective This systematic review aims to synthesize existing evidence on emergency department (ED) experiences, service-delivery challenges, and environmental and communication factors affecting autistic people and to identify strategies and interventions reported to improve patient comfort, safety, and satisfaction. Methods A comprehensive search was conducted across databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, for peer-reviewed articles published between January 1, 2014, and December 31, 2024. Data extraction was performed using standardized forms, and quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Data synthesis involved narrative thematic analysis to identify key barriers and facilitators to emergency department care for autistic people. The reporting of this review follows the PRISMA guidelines. Results Eleven studies met the inclusion criteria and revealed consistent barriers affecting autistic people in emergency departments. Across settings, communication difficulties, sensory overload, long waiting times, and limited staff preparedness were the most frequently reported challenges. These factors contributed to heightened distress, behavioral escalation, and reduced satisfaction for patients and families. Facilitators identified in the literature included ASD-specific staff training, sensory-adapted environments, structured care routines, and active caregiver involvement. While not all barriers are easily modifiable, several environmental, communication, and workflow-related factors appear potentially amenable to service-level interventions. The findings further indicate that autism-specific staff training, sensory-friendly adaptations, and caregiver-supported care approaches may improve the ED experience for autistic patients and their families. Discussion The findings underscore the multifaceted challenges ASD patients face in EDs, exacerbated by sensory overload and communication difficulties. Addressing these issues requires a comprehensive approach, including staff education, environmental adjustments, and efficient triage systems. Engaging parents as partners in care also emerged as critical for delivering patient-centered care. Conclusion This review emphasizes the urgent need for systemic reforms in ED care for ASD patients. Strategies such as sensory-friendly environments, enhanced staff training, and patient-centered policies can improve patient outcomes and satisfaction. Future research should focus on evaluating the long-term impacts of these interventions and identifying innovative solutions to meet the complex needs of this vulnerable population. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024532107, PROSPERO CRD42024532107.