Urgent attention is needed to address the health inequalities that people with a learning disability face in the hospital setting, according to a new study. This includes patient safety outcomes and adverse events, quality of care, maternal and infant outcomes and postoperative outcomes.

The research published in BMJ Open was the first scoping review to synthesise both the academic and grey literature focusing on hospital patient safety outcomes for people with learning disabilities from January 2000 to March 2021.

It also identified a range of potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.

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The authors said that although promising interventions and examples of good practice exist, many of these have not been implemented consistently and warrant further robust evaluation.

Staff regularly fail to make reasonable adjustments 

The study said that some ‘direct effects’ of having a learning disability were likely to have an impact such as the increased incidence of comorbidities in children with learning disabilities, which could account for the increased likelihood of postoperative complications.

Yet there were multiple ‘indirect effects’ of having learning disabilities that may amplify problems. This included inadequate systems to identify and flag people with a learning disability when they entered an acute hospital setting, which limited the development of much needed solutions to address patient safety issues.

Other indirect effects included problems with communication, staff attitudes, staff awareness and knowledge/training and variation in the quality and level of healthcare received.

The authors said: "Without specific knowledge of, and training in caring for those with a range of learning disabilities, it is perhaps understandable that staff regularly fail to make reasonable adjustments to accommodate specific needs."

A key finding from a qualitative study with medical practitioners concluded that practitioners make limited use of ‘reasonable adjustments’ and turned to caregivers to facilitate communication and manage behaviours likely to upset hospital routines

Consistent good practice and interventions needed 

Interventions and good practice examples identified included risk assessment tools, preoperative and perioperative management recommendations, hospital passports and education modules as well as learning disability teams. Yet these are not always widely available or are applied inconsistently.

The research highlighted the need to reduce ambiguity about the role of the parent and the importance of clarifying what carer involvement includes. It found a range of evidence that suggested families and carers regularly ‘prop up services—from helping with feeding and personal care, to facilitating communication and being involved in discharge planning—and that without this ‘prop, the outcomes for patients with learning disabilities may well be poorer.

The authors concluded: "There is already a wealth of learning about the problems that exist for people with learning disabilities and their families, what is needed now is policy level action."