2023 14th Annual NUBE Conference

Introduction: There is a scarcity of research on the optimal method for delivering care to individuals with autism spectrum disorders (ASD) and Intellectual Disorders (ID) who experience sudden agitation and seek emergency medical attention (1). At the same time, ED personnel identify clear guidelines as one of the most important resources for improving their self-perceived competence in managing patients with neurodevelopmental disorders (NDD). Current study draws upon the available evidence-based approaches to create a training session for Montefiore psychiatry residents, summarize the key points in a pre-written sequence of steps to be uploaded into the electronic medical record (EMR), and a Health Passport that promotes collaboration with patients’ families and caregivers to provide a safe and therapeutic ED experience. Additionally, there is a paucity of published assessments of psychiatry residents’ level of competence in treating agitated patients with NDD. Given that psychiatric providers are frequently the ones treating acute agitation in the ED, this study seeks to explore self-perceived competency of Montefiore psychiatry residents and strategies to address competency gaps.Method: This is an interventional prospective study to implement and evaluate evidence-based interventions to improve the management of acute agitation in a pediatric emergency department. The interventions include, 1) a training module for psychiatric residents in evidence-based approach to agitation in pediatric patients with neurodevelopmental disorders (NDD); 2) an Epic dot phrase outlining pharmacologic and non-pharmacologic interventions for the studied patient population; and a Health Passport to be completed by patients’ caregivers to inform the psychiatric ED care team about potential warning signs, calming techniques, and any additional needs the patient may have. Evaluation will be done through retrospective chart review and resident surveys pre and post the training session. Descriptive statistics will be computed to describe the characteristics of the residents of the analysis groups: the post-training group and the historical control group. Patterns of PRN and seclusion orders identified through a retrospective chart review will also be characterized and presented.Results:Study is ongoing and preliminary results of both surveys and retrospective chart analysis are expected to be available in September 2023. Interventions such as the Epic dot phrase which summarizes evidence-based guidelines, training module and health passport have already been designed and ready for implementation.Conclusion:Management of acute agitation in patients with NDD within emergency settings can be challenging and potentially pose a safety risk for both residents and nursing staff. Characterizing use patterns of PRN medications and restrictive methods such as seclusion may allow for the identification of gaps in evidence, and opportunities for improvement. Targeted interventions such as staff training, implementing a health passport and evidence-based guidelines can help guide clinical staff in their management of acute agitation and create a safer environment for both staff and patients.

Learning Objectives:

1. Discuss evidence-based guidelines for management of acute agitation in children with neurodevelopmental disorders in emergency settings.
2. Introduce quality improvement interventions to improve management.