This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines ²¹. An a priori protocol outlining the review objectives, eligibility criteria, data sources, and synthesis methods were developed to enhance transparency, reproducibility, and consistency in study selection and data extraction. Consistent with scoping review methodology, the purpose of the review was to map the scope, content, and implementation features of hospital-based sensory accessibility policies rather than to assess policy effectiveness or conduct formal quality appraisal.

We searched MEDLINE (via Ovid), Embase, CINAHL, PsycINFO, and Scopus from database inception to December 2025. Search strategies combined controlled vocabulary and free-text terms across four domains: (1) hospitals and clinical settings (including emergency departments, inpatient wards, perioperative settings, and diagnostic imaging); (2) sensory environment concepts (e.g., sensory-friendly design, noise, lighting, sensory overload); (3) disability-related terms (including autism, neurodiversity, intellectual disability, and sensory processing differences); and (4) policy and protocol terminology (e.g., policy, guideline, pathway, toolkit, standard operating procedure). Search strategies were adapted for each database to capture literature across health services research, nursing, rehabilitation, disability studies, and quality improvement. Reference lists of included sources were screened to identify additional relevant materials, and targeted grey literature searches were conducted to capture institutional guidance documents, policy reports, and implementation descriptions not indexed in academic databases.

Sources were eligible for inclusion if they: (1) described hospital-based policies, protocols, pathways, or institutional standards explicitly aimed at reducing sensory barriers in care environments; and (2) focused on disabled patients or populations with sensory accessibility needs. Eligible sources included empirical studies, quality improvement initiatives, implementation reports, and policy evaluations using qualitative, quantitative, or mixed methods approaches. Sources were excluded if they consisted solely of commentary without policy description, focused on non-hospital settings such as outpatient-only clinics, or did not address sensory accessibility as a defined policy or protocol objective.

Two reviewers independently screened titles and abstracts, followed by full-text review of potentially eligible sources using predefined inclusion and exclusion criteria. This dual-reviewer process was employed to enhance consistency and reduce selection bias. Disagreements were resolved through discussion and consensus, with a third reviewer adjudicating unresolved cases when necessary. Reasons for exclusion at the full-text stage were documented to support transparency in study selection.

Data were extracted using a standardized charting form capturing care setting, patient population, policy or protocol components, implementation supports (such as staff training, designated champions, or audit mechanisms), outcomes measured and reported barriers and facilitators to implementation. The charting framework was piloted and refined iteratively as new policy features and implementation strategies emerged. Findings were summarized descriptively and organized into themes to identify cross-cutting patterns in how hospitals conceptualize, operationalize, and sustain sensory accessibility initiatives, rather than comparing institutions or rank policy effectiveness.

Consistent with scoping review methodology, we did not conduct formal critical appraisal, as the objective was to map the breadth, characteristics, and implementation features of available literature rather than determine intervention effectiveness.

A total of 2,402 unique records were identified through database searching, of which 88 full-text sources were assessed for eligibility, and 35 were included in the final synthesis. Across settings, the literature consistently framed sensory conditions, particularly noise, bright lighting, crowding, and unpredictable interruptions, as clinically meaningful barriers that can escalate distress and disrupt care processes for neurodivergent and disabled patients. Four overarching themes were identified: (1) policy scope and definitions, (2) standardized accommodation pathways and tools, (3) workforce training and accountability, and (4) uneven implementation and limited evaluation.

Policies varied widely in how they defined “sensory-friendly care,” ranging from broad commitments to accessibility and inclusion to highly specific operational standards such as noise-reduction expectations, lighting adjustments, or designated low-stimulation spaces ^7,8. Most sources were anchored in autism and developmental disability contexts, commonly framing sensory overload as a driver of distress-related behaviors, communication breakdown, and care disruption, particularly in high-stimulation environments like emergency departments ^5,20,22. In contrast, fewer policies explicitly positioned sensory needs as a cross-disability accessibility issue relevant to patients with a wide range of impairments and conditions, despite evidence that sensory distress can meaningfully limit care participation and informed consent across neurodevelopmental and neurological populations ^9-11,14. Many policies used flexible, individualized language (e.g., “reasonable accommodations,” “person-centred supports”) but did not specify minimum baseline standards that should be routinely available, which the disability-access literature cautions can shift responsibility from system design to individual staff discretion and thereby generate inconsistent access across units and shifts ^14,23. Few sources explicitly connected sensory-friendly care to disability rights, nondiscrimination obligations, or human rights frameworks, even though a rights-based approach is frequently described as foundational to equitable healthcare access and to institutional accountability for accommodations ^24,25.

Policies varied widely in how they defined “sensory-friendly care,” ranging from broad commitments to accessibility and inclusion to highly specific operational standards such as noise-reduction expectations, lighting adjustments, or designated low-stimulation spaces ^7,8. Most sources were anchored in autism and developmental disability contexts, commonly framing sensory overload as a driver of distress-related behaviors, communication breakdown, and care disruption, particularly in high-stimulation environments like emergency departments ^5,20,22. In contrast, fewer policies explicitly positioned sensory needs as a cross-disability accessibility issue relevant to patients with a wide range of impairments and conditions, despite evidence that sensory distress can meaningfully limit care participation and informed consent across neurodevelopmental and neurological populations ^9-11,14. Many policies used flexible, individualized language (e.g., “reasonable accommodations,” “person-centred supports”) but did not specify minimum baseline standards that should be routinely available, which the disability-access literature cautions can shift responsibility from system design to individual staff discretion and thereby generate inconsistent access across units and shifts ^14,23. Few sources explicitly connected sensory-friendly care to disability rights, nondiscrimination obligations, or human rights frameworks, even though a rights-based approach is frequently described as foundational to equitable healthcare access and to institutional accountability for accommodations ^24,25.

Most sources included concrete tools or standardized pathways intended to operationalize accommodations within real clinical workflows rather than relying on ad hoc responses ^17,20. Sensory toolkits were among the most common components and typically included items such as noise-cancelling headphones, sunglasses, fidget tools, weighted items, and visual timers, reflecting a broader trend toward low-cost, deployable supports for self-regulation and distress reduction in acute care settings ^17,26. Quiet spaces and designated low-stimulation rooms were frequently described as core environmental supports, aligning with pediatric emergency guidance that recommends reducing stimulation through quieter/private spaces and limiting unnecessary personnel in the room to prevent escalation and facilitate assessment ^5,20. Many policies incorporated pre-visit planning mechanisms, such as sensory profiles, “about me” forms, and individualized coping plans, to enable anticipatory accommodation planning and reduce uncertainty during encounters, particularly for patients with neurodevelopmental and communication differences ^27,28. Communication supports were also central, including visual schedules, plain-language scripts, augmentative and alternative communication (AAC) awareness, and predictability checklists, reflecting evidence that communication accommodations are often the most actionable and consistently implemented disability supports when embedded into routine care processes ^23,28,29. Imaging and perioperative policies frequently emphasized preparation scripts, desensitization strategies, and environmental control (e.g., modifying lighting and sound, minimizing staff transitions) to reduce distress and incomplete procedures, mirroring broader perioperative literature demonstrating that structured pathways and multimodal preparation can improve procedural success and patient experience ^26,30-32.

A consistent distinction across sources was between policies functioning primarily as resource lists and those embedded into clinical systems through workforce training, role clarity, and accountability infrastructure ^33,34. Policies with stronger implementation scaffolding commonly included required staff education (e.g., onboarding modules, simulation-based training, and unit refreshers), reflecting evidence that staff confidence and skill in disability accommodations are critical determinants of whether sensory support is offered consistently, especially in high-turnover and high-acuity environments ^34-37. Role clarity was repeatedly emphasized, including specifying who offers sensory support, who documents accommodation needs, and who escalates barriers, which aligns with implementation science findings that diffusion of responsibility contributes to inconsistent delivery of accommodations ^18,34. Multiple sources emphasized documentation pathways within the electronic health record (EHR), such as flags, accommodation orders, and care plans, as a mechanism to support continuity across shifts and reduce repeated disclosure burdens, consistent with qualitative work showing that accommodations are more reliably delivered when embedded in visible and standardized documentation workflows ^38,39. Where policies lacked training, role clarity, and EHR integration, sensory accommodations were more likely to depend on individual clinician goodwill, producing uneven access within and across hospitals, which parallels broader disability-access literature on variability when accommodations are not systematized ^14,25.

Only a minority of sources reported systematic evaluation beyond satisfaction surveys, descriptive reporting, or anecdotal implementation accounts, and quantitative outcomes, when reported, were heterogeneous in definition and measurement ^40,41. Across evaluated sources, outcomes most included patient and family experience, procedure completion (especially in imaging contexts), distress escalation events, and reported changes in restraint or sedation use, although attribution to specific policy components was frequently unclear ^42-44. This measurement variability aligned with methodological critiques in the restraint and restrictive-practice literature, which note inconsistent reporting standards and limited psychometric validation of instruments used to assess experience and safety outcomes, constraining comparability and confidence in observed effects ^40,44. Reported implementation barriers included limited availability of quiet spaces, challenges maintaining and replenishing sensory supplies, staff time constraints, skepticism about feasibility in high-acuity areas, and perceived conflicts with infection control or safety procedures when these trade-offs were not proactively addressed in policy design ^45,46. Several sources highlighted that without measurement infrastructure, such as audit mechanisms, adherence indicators, and standardized definitions, policies risk becoming symbolic rather than operational, echoing broader guidance emphasizing that systematic monitoring and feedback loops are necessary for reducing coercive practices and achieving reliable implementation ⁴¹. Overall, the literature suggested that scaling sensory-friendly care requires not only practical tools and environmental modifications, but also institutional investment in evaluation capacity to assess effectiveness, equity impacts, and sustainability over time ^18,44.