HOPEWELL TOWNSHIP — A trip to the emergency room can be unpleasant for anyone in pain or discomfort. But for children and adolescents with autism, the fast-paced environment and bright lighting only adds to the trauma.

 

“For patients with autism and for their families or caregivers, this can be a nightmare experience,” said Dr. Olga Goldfarb, director of the Autism Program at Capital Health’s Institute for Neurosciences. “They have problems interacting and approaching other people. It can be very scary for those with autism.”

 

To help make the hospital atmosphere more inviting for such patients, Capital Health Medical Center – Hopewell on Wednesday is launching what it calls the first “autism-friendly” pediatric emergency department in New Jersey.

 

Hospital staff in the pediatric unit spent the past few months receiving specialized training to recognize behaviors associated with autism and provide a calming setting to better cater to patients' specific needs, said Heather Keller, nurse manager of pediatric services.

“They do not like fluorescent lighting at all, so you turn down the lights. We have an overhead light that we shine in the corner,” Keller said.

 

In the 1990s, about one in 10,000 individuals were diagnosed with autism nationwide; that figure now stands at one in 68, according to the Centers for Disease Control and Prevention. In New Jersey alone, one in 45 people are diagnosed, and that population is expected to increase.

The consensus among health professionals is that about half of that increase is due to better recognition and diagnosis of the disorder at an early age as well as the broadening of the spectrum used to define autism.

 

“There’s a whole debate out there also about whether we missed them before or whether we’re overdiagnosing now or whether it’s a combination of all of that," said Dr. Zach Kassutto, director of the pediatric emergency department. "But the numbers are up, big time."

 

The 17-bed pediatric emergency department at Capital Health – Hopewell is separate from its adult emergency department. The “autism-friendly” pediatric department will be rolled out in Hopewell first, with the intention to expand it.

 

The program was developed with Scott Serbin of Emergency Medical Associates, who helped institute one of the first programs of this kind at a hospital in Kingston, N.Y. But Keller took it a step further, she said.

 

In addition to training, a parent focus group consisting of five Mercer County mothers met with staff earlier this month to refine the program and discuss ways the hospital could better deliver care to children with autism.

 

Toys, blankets and other objects of different textures will be located in the nurses’ stations in sensory boxes with drawers labeled “soft,” “squishy,” “hard,” “noisy” and “shiny,” depending on a patients’ preferences.

 

“We just learned so much from them. They talked about how autistic kids like to have their arms brushed, so we got these kits that will be passed out to the parents and they can take them home with them,” said Keller, holding up a brush and demonstrating on her arm.

One mother said she was willing to travel more than an hour to a hospital where her child with autism was treated special, Keller recalled.

 

“I was not aware how difficult it was for them to find a coordinated response for their child’s care needs,” said Dr. William Dalsey, chair of the department of emergency medicine at Capital Health. “Many autistic children have other medical problems and they have a very difficult time finding a specialist.”

 

Sometimes patients with autism are nonverbal or minimally verbal, making it difficult for staff to administer treatment, Goldfarb said.  “They have a lot of symptoms that will make the testing in the ER difficult. They are sensitive and don’t like to be touched,” she said.

 

Pediatric emergency nurses will also use iPads with apps designed to help staff communicate with patients with autism and those who are verbally impaired. The technology helps medical providers learn why the patient arrived, their pain levels and communication preferences.

 

It also enables staff to explain what the patient can expect during their visit to eliminate fear or confusion, Keller said.

 

“We’ve got all these tricks up our sleeves, but it’s not so much about the hardware or software,” Kassutto said. “It’s really, in my mind, about working with parents and working with the kids and really listening.” 

 

Posted October 20, 2014