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Quantifying emergency department admission rates for people with a learning disability
  1. Tim Williamson1,2,
  2. Joanne Flowers3,
  3. Matthew Cooke3,4,5
  1. 1University of Leicester Medical School, Leicester, UK
  2. 2Emergency Department, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
  3. 3Emergency Department, Heart of England NHS Foundation Trust, Birmingham, UK
  4. 4University of Warwick Medical School, Coventry, UK
  5. 5Department of Health, London, UK
  1. Correspondence to Dr Tim Williamson, Department of Medical and Social Care Education, MSB, PO Box 138, University Of Leicester, Leicester, LE1 9HN, UK; tw54{at}le.ac.uk

Abstract

No data is routinely collected by emergency departments (ED) in the UK to identify people who attend and who have a learning disability. This group have numerous additional needs in their healthcare management and a lack of support could be detrimental to their care. F800 codes from the International Classification of Diseases (ICD-10) that identify disorders of psychological development are often used to categorise specific disorders once admitted to hospital. Consequently, the F800 codes of patients who were admitted to hospital from Birmingham Heartlands Hospital ED for 1 year have been analysed to obtain some of this data. This study argues that, although only a small proportion of the admissions from this ED were by people with an F800 code, the exact numbers of attendances in many EDs remain unknown and the impact of their disabilities on their immediate care and the workload of the ED medical staff may be significant.

  • Care systems
  • clinical assessmentemergency departmentmental healthnursing
  • emergency care systems

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Introduction

People with a learning disability have specific requirements within the healthcare setting, which can be amplified at times of extreme emotional upset and physical trauma. At present, no code is commonly used in the UK to document the number of people with a learning disability that attend the ED. However, once admitted the International Classification of Diseases (ICD-10)1 is often used to specify specific disorders and illnesses. The F800 code is used within this classification for people who have disorders of psychological development. This paper aims to identify the number of people with a learning disability admitted via an ED over a 1-year period. In turn this will identify a group of individuals who require more intensive supervision and potentially time consuming care in this acute environment. This will be completed by presuming that those documented under F800 codes have an unspecified level of a learning disability.

Methods

Admission data from Birmingham Heartlands Hospital was used to identify all patients admitted from the ED with an ICD-10 F800 code between 1 April 2009 and 31 March 2010. The data obtained included the patient's age, sex and F code. This was then broken down to the individual F800 codes. No ethics approval was required as routine anonymised data was analysed.

Results

A total of 246 (4%) of patients who were admitted to Heartlands Hospital via the ED had an F800 code during the period of 1 April 2009 to 31 March 2010. Of these, 21 had 2 F800 codes and therefore a total of 267 codes were documented. In all, 94 (38%) were between the age of 0 and 15; 118 (48%) were between 16 and 64 years; and 34 (14%) were 65 and over. No documentation was viewed to ascertain if a family member or carer was present with the patient during their time in the emergency department. The individual F800 attendance codes were documented in table 1.

Table 1

Breakdown of the emergency department (ED) admissions between 1 April 2009 and 31 March 2010 of patients that had F800 codes

Discussion

This analysis shows a significant number of patients with a learning disability are admitted from EDs. The number who attend the department but are not admitted is not known as this would not be coded. Despite these significant numbers it is understood that many EDs in the UK do not have a specifically trained member of staff to support people with a learning disability. The specific issues to be addressed may include: Problems with communication and processing information; increased behavioural abnormality due to physical and mental trauma; and increased possibilities of self-harm. Any lack of a supportive mechanism and limited education in this field may lead to the poor management of this group. This is supported by previous research suggesting that ‘emergency healthcare workers do not have adequate knowledge about how to assess capacity and treat people who either refuse treatment or lack capacity’.2 Documentation of consent and refusal of treatment are critical for quality of patient care and legal liability reasons.3 Therefore, knowledge of the three essential features of informed consent are paramount: patient capacity, disclosure of information and voluntariness.4 Patients in the ED frequently voice refusals of care or are unable to consent to care5 and abandoning a requirement for consent is an emergency exception to the ethical and legal principles. This only comes into play when a person lacks decision making capacity.6 This could mean that treatment of a person with a learning disability may be undertaken with minimal patient discussion, believing that they have no capacity and causing undue stress to the patient involved. A member of staff specifically trained in these issues may reduce the time involved in the management of people with a learning disability as well as increasing quality of care. The small numbers seen in this analysis would make it difficult to justify a 24 h presence of such staff. More accurate data on attendances may however show that the need is greater than current data suggests.

References

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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