Taking the Work Out of Blood Work: A Provider's Guide

Environment

Patient Flow within the Clinic.

In most medical settings, there is a standard order of events that occur during a clinic visit. When working with patients with ASD, it is important to consider how aspects of each step of this process may be altered to ensure the most efficient and successful patient flow. Modifications may include:

• Scheduling
  • Schedule patients with ASD for the first or last appointment of the day (when the office is less busy).
  • If the patient will have to undergo multiple blood draws for different reasons, consider coordinating them to be completed with 1 stick rather than multiple sticks.
  • If the patient will be sedated for a different procedure, considering scheduling the blood draw while the patient is under sedation.
• Check-in and Waiting Room
• Determine tasks that can be conducted prior to the appointment or while the patient is not present and waiting (e.g., initial paperwork, history from the parent)
• Identify the quickest way to move through or bypass initial steps (e.g., checking in, waiting in the waiting room). You may consider moving your patient into a private room or a smaller waiting room to minimize distress for your patient and minimize disruption for your other families.
• Have supports available in the check-in and waiting area for families to use with their child during these steps.
• Vital Signs and Physical Exam
• Find out if certain aspects that are typically routine are not essential during that appointment for this particular patient (e.g., aspects of the physical exam)
• Exam Room and Blood Draw
• Set up equipment and all necessary materials prior to the patient entering the room to maintain a steady pace and lessen opportunities for distress and challenging behaviors.
• Setting up the room in a way where the patient is at the farthest point from the door and staff is present between the door and the patient. This may help keep the patient and staff safe if the patient attempts to elope from the room.
• Consider if there is an exam room available that is further away from the waiting room in order to decrease discomfort that families in the waiting room may experience if your patient engages in challenges behaviors that could be overheard.
• Set up the room in a way where the patient is at the farthest point from the door and staff is present between the door and the patient. This may help keep the patient and staff safe if the patient attempts to elope from the room.
• Adjust environmental variables in the exam room that create a less stimulating and more comfortable environment for your patient, such as less light, ambient light instead of fluorescent light, decreased noise level, decreased clutter in the room, an appropriate temperature, etc.
• Identify an exam room that permanently will permanently have available supports and that has already accounted for the environmental modifications suggested, rather than having to re-create this for each patient.
• Minimize the number of transitions during the appointment if possible (e.g., take vitals, conduct the physical exam, and complete the blood draw in the same exam room).
• If phlebotomy must occur in a laboratory setting instead of the doctor’s office, consider scheduling an appointment to minimize wait time.

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These materials are the product of on-going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks. It is supported by cooperative agreement UA3 MC 11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. Website hosting, design, and maintenance provided by the Vanderbilt Kennedy Center.