Enhancing Adult Autism Diagnostic Pathways: the role of clinical triage in efficient service provision

Background: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and repetitive or rigid behaviours, affecting 1.1% of adults. The increasing incidence of ASD has led to pressurized diagnostic services, with specific challenges such as limited specialist workforce, lengthy waiting lists, and complex multidisciplinary evaluations that are not economically favourable. Objective: To determine the number needed to harm (NNH) of criteria-informed triage assessment in an adult autism diagnostic service in the UK. Methods: The study was conducted at a specialist adult Autism Service in West Yorkshire, UK, from November 2021 to August 2022. All eligible referrals were accepted, with criteria requiring service users to be over 18 years old and without an intellectual disability. The evaluation consisted of 60 cases. Results: None of the evaluation cases resulted in a clinical diagnosis of ASD, yielding an infinite number needed to harm (NNH), demonstrating that every case benefiting from the triage process without significant risk of harm.Conclusions: Triage enables services to gather comprehensive information about individual presentations and clinical needs, facilitating informed decision-making and better service utilisation. The evaluation demonstrates the safety and effectiveness of the triage process, with directions for further research discussed.