People with developmental disability at high risk of avoidable in-hospital safety incidents

People with developmental disability are nearly three times as likely than other patients to experience preventable physical injuries while in hospital, reveals new research by the London School of Economics and Political Science (LSE) and the Universitat de Barcelona.

The paper, published today (Monday 3 October) in the October issue of the journal Health Affairs, looks at the prevalence of five avoidable in-hospital patient safety incidents for adults with developmental disability in English NHS hospitals between April 2017 and March 2019.

The researchers considered cases of adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative deep vein thrombosis and postoperative sepsis.

They found that these avoidable in-hospital safety incidents increased the risk of death for adults with developmental disability by up to 15 per cent.

Patients with chromosomal abnormalities, such as Down's Syndrome, were particularly at risk, being 14.7 per cent more likely to die from postoperative sepsis and 14.5 per cent more likely to die from hospital-acquired infections than patients without developmental disability.

In addition, avoidable patient safety incidents led to people with developmental disability spending up to 15.4 days longer in hospital as compared with other patients.

Dr Rocco Friebel, Director of the Global Surgery Policy Unit at LSE and lead author of the paper, said: "Our research shows that there is a persistent difference in the quality of care that patients with developmental disability receive.

"We need an explicit national policy focus on the needs of these patients to ensure they receive the same care as others. Not only is this essential to reduce inequality of care but it will also lower the burden on the NHS' resources.

"While our research was unable to identify what underlying factors were causing harm, more emphasis must be given to how to communicate effectively with people with developmental disability, as well as improving their basic care and tackling delays in diagnostics and treatment.

"Including a patient's caregiver as part of the hospital care team could also be key, since they will be quicker to notice when an individual's health has deteriorated."

The study also found that, on average, inpatients with developmental disabilities were ten to twenty years younger than the general hospital population.

These findings suggest that there are ongoing challenges in the provision of adequate services within the community to enable an individual with a developmental disability to live a healthy life.

So while our findings support the current UK government objective to shift care for patients with learning disability and autism from the hospital to the community in England - which may reduce the number of patients exposed to these patient safety failures - it's clear this will require significant strengthening of existing community services."

Dr Laia Maynou, Lecturer Serra Hunter at the Universitat de Barcelona and co-author of the paper

The study considered the experiences of patients from four developmental disability groups: people with intellectual disability; chromosomal abnormalities; pervasive developmental disorders; and congenital malformation syndrome.

Source:
Journal reference:

Friebel, R & Maynou, L., (2022) Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017–19. Health Affairs. doi.org/10.1377/hlthaff.2022.00493.

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