Improving Paediatric A&E Environments for Neurodiverse Children and Young People

Abstract

Background

Paediatric emergency departments (PEDs) can present significant sensory overload to neurodiverse children, often resulting in challenges with accessing healthcare. The RCPCH Facing the Future Standards for Paediatric Care advises that PEDs adapt to suit the needs of children with complex needs, and the design and planning of departments should involve feedback from patents and families.1 Ideally, many departments would assign neurodivergent patents to a cubicle upon arrival to mitigate sensory overload, but such spaces are frequently at capacity due to high clinical acuity. This necessitates alternative adjustments to facilitate equitable care for these patients.

Objectives

The primary objective was to run a cross-site patient feedback survey at two PEDs at two linked hospitals to understand theexperience of neurodiverse patients in the emergency department waiting room. The secondary aim is to identify possible areas for improvement.

Design & Intervention
A 15-question survey was created using a mixture of Likert scale, binary and short answer open questions. The survey was advertised in the waiting room at the two hospitals on a poster with a QR code and hard copies were also distributed to families with neurodiverse children aged 0-15 years. Responses were collected from November 2024 to February 2026.

Results
79 responses were obtained. None of the patients had a hospital passport or emergency care plan communicatng their needs.72% (57/79) said the waiting room is overwhelming for their child. After triage, 50.6% (40/79) would prefer a quiet room to wait for assessment and 23% (18/79) would also like to provide their phone number and wait elsewhere until called. Items that wouldhelp children to remain calm in the waiting room: stress balls (60.8%, 48/79), headphones (48.1%, 38/79), story books (40.5%,32/79) and barrier screens (26.6%, 21/79). 62% (49/79) believed it would be beneficial for their child to interact with a playtherapist in PED.

Implications & Wider Relevance
Our trust aims to provide a sustainable approach to the emergency care of neurodiverse children. We suggest adjustments such as updating the trust website for better preparation on attending PED, use of hospital passports, distraction tools and creative technology-based solutions for managing the waiting area.