AURA Protocol: A Territorial Needs-Assessment Methodology for Autism-Adapted Hospital Access, Demonstrated Through a Case Study in Lleida, Spain

Background. Conventional hospital environments generate systematic sensory overload, communication barriers, and procedural difficulties for patients with Autism Spectrum Disorder (ASD). Despite established international guidelines (NICE CG142, NHS England 2025) and existing regional initiatives in Spain (M'adapTU at Vall d'Hebron Hospital; Autismo Andalucía Healthcare Protocol), the present study identified no formalised hospital access route for autistic patients in the territory examined; the extent of this gap across Catalonia as a whole would require separate systematic verification. The AURA Protocol (Atenció Universal Respectuosa de l'Autisme, lit. Universal Respectful Autism Care) is a structured operational response to this territorial gap, developed from original territorial research. Objective. To propose a standardised research instrument for territory-specific ASD needs assessment, replicable across heterogeneous territorial and hospital contexts to identify locally specific critical areas; to document, through the instrument's first application, the clinical needs of an ASD community in a territory with no formalised hospital access protocol; and to translate the resulting territorial evidence into a scalable, consensus-ranked operational framework. Methods. Mixed observational descriptive study. Structured 23-item questionnaire (9 Likert scales 1-5, open-ended questions, multiple-choice items) administered digitally to ASD families in the territory (N=15). Descriptive statistical analysis for quantitative scales; deductive thematic analysis for open-ended responses. Results. Four domains reached or exceeded a mean severity of 4/5: overstimulating environments (4.27), procedural difficulties (4.20), waiting times (4.00), lack of anticipatory preparation (4.00). Intervention consensus: staff training (100%, 15/15), companion access during procedures (93.3%, 14/15), structured initial assessment (86.7%, 13/15). Operational proposal. Three sequential interventions implementable at under 300 euros in material cost, exclusive of staff time. Clinical, process, and satisfaction indicators defined for pilot cycle evaluation. The three interventions and the screening instrument presented here are the specific output the methodology produced for Lleida. The transferable contribution is the methodology itself, designed to generate a differently weighted package wherever it is reapplied, at minimal material cost and without specialist infrastructure.