When You Can’t Say What Hurts

A lifesaving protocol for patients with autism at HealthAlliance Hospital

By Judith Acosta, LISW, CCH

With all its noise, bright lights and general chaos, can an emergency room ever be autism-friendly?

According to Amy Gutman, MD, Medical Director of the Emergency Department of HealthAlliance Hospital, a member of the Westchester Medical Center Health Network, the answer is an unequivocal “yes.”

Autism spectrum disorder — which affects 1 in 68 children in the United States, according to the Centers for Disease Control and Prevention — is a condition that in some cases profoundly affects an individual’s ability to communicate verbally or to process environmental stimuli in a neurologically typical manner. According to Dr. Gutman, who is also the mother of a child with special needs, this makes standard emergency-room treatment quite challenging. Communication is very difficult for many children on the autism spectrum, even when they are in familiar surroundings, with people they know and trust. When you factor in the conditions of a typical ER, those difficulties are compounded.

“The way we do it is by making it a safer place for everybody,” Dr. Gutman explains. “We have private rooms that have multiple lighting options, warm blankets and glass doors and curtains for privacy. We also try and limit the number of staff members in a patient’s room at any one time so as not to overwhelm those with sensory concerns or shyness with strangers.”

All HealthAlliance staff members have undergone training to ensure that all patients, especially those with unique challenges, are as comfortable as possible. With ratings in the 95th percentile for patient–staff interaction, the hospital’s satisfaction scores seem to validate the investment.

Dr. Gutman believes that what truly makes HealthAlliance special is that its policy is extended to everyone who walks in the ED, not just those with special needs. “We’ve done our best to make all of our rooms and physical spaces comfortable for all of our patients,” she explains. “We’ve made iPads, toys, sensory-comfort items and blankets available to anyone who needs them.”

As the mother of a child with special needs, Dr. Gutman’s own experience in the ER has informed her work in a very personal way. “My son has special needs, but more importantly is a rambunctious kid, and has had to be seen in our ED a number of times since I started here,” she shares. “Like any person with many hospital and doctor visits, he is naturally anxious in anticipation of pain.”

According to Dr. Gutman, the process to decrease stressors and anxiety for all patients starts at the registration desk. First, the clerk brings the patient to a quiet room, with a parent or guardian, if appropriate, and speaks to the patient quietly and directly, using simple language. The clerk asks for permission before putting the patient’s wristband on him or her, then takes the patient directly to a dimly lit, private room where initial triage questions are asked quickly, yet calmly. The patient is allowed to remain dressed and has access to comfort items. Likewise, the doctor asks permission to perform an exam, continuing to explain everything calmly and in simple language. All staff members are trained to not interrupt patients who may be using an iPad, or another form of distraction, even if it means slowing the completion of the exam.

In essence, no matter who the patient is, the goal in the ED is the same: Minimize all wait times, explain the plan often, let him or her know of changes, and inquire about his or her comfort multiple times during the visit. “The main thing,” adds Dr. Gutman, “is that although we are incredibly proud of our autism-friendly programs, I am more proud of how we treat every patient like an individual whose autonomy and dignity is absolutely respected.”

Pictured: Amy Gutman, MD (center); Rebecca Blackwell-Hafner, Emergency Department RN; and Hugo King, Emergency Department Tech, with the autism-friendly resources in the Emergency Department.