Understanding staff views on managing individuals with developmental disabilities in hospital emergency departments: A starting point for quality improvement

Background

Adults with developmental disabilities (DD) experience significant health challenges, and have high rates of hospital emergency department (ED) visits and return ED visits. Quality of care concerns have been reported by patients with DD, their caregivers and by ED staff. To begin improving practice in 3 hospital EDs in Ontario, ED staff were surveyed about their knowledge, skills and current practices when caring for patients with DD.

Method:

The study survey was based on existing surveys, adapted to the ED context. Staff were invited to anonymously complete the survey at rounds, team meetings and information events. Across the 3 sites, 153 staff completed surveys.

Results:

Most staff had cared for a patient with DD in the past year but few reported using specific strategies to identify these individuals. Few also reported regularly modifying care (e.g., checking for behavioral triggers and clearly explaining next steps at discharge), and many reported not feeling knowledgeable about common co-morbidities and care issues. Many staff also reported lacking time and resources to make desired accommodations, which were also seen as barriers to future improvement efforts. Site variances were present.

Discussion

Quality improvement cannot be initiated without knowing staff needs and local service context. Follow-up practice change work is underway at each site, considering staff needs, feasibility, and informed by evidence. A follow-up survey will monitor staff perceived changes in practices and resource supports. Improved identification of patients with DD and indicators of improved discharge are also being monitored.