An audit of the quality of inpatient care for adults with learning disability in the UK.
OBJECTIVE
To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver.


METHODS
Nine acute general hospital Trusts and six mental health services.


METHODS
Adults with learning disability who received inpatient hospital care between May 2013 and April 2014.


METHODS
Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed.


RESULTS
Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit.


CONCLUSIONS
Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
Division of Psychiatry, University College London, London, UK.
Rory
R
Sheehan
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Aarti
A
Gandesha
Division of Psychiatry, University College London, London, UK.
Angela
A
Hassiotis
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Pamela
P
Gallagher
Faculty of Population Health Sciences, University College London, London, UK.
Matthew
M
Burnell
Abertawe Bro Morgannwg University Health Board, Cardiff, UK.
Glyn
G
Jones
Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK.
Michael
M
Kerr
Tower Hamlets Community Learning Disability Service, London, UK.
Ian
I
Hall
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
Robert
R
Chaplin
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK Centre for Mental Health, Imperial College London, London, UK.
Michael J
MJ
Crawford
D000328:Adult; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007859:Learning Disabilities / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care / Q000592:standards*; D006113:United Kingdom
Learning (intellectual) disability; Learning Disability Liaison Nurse; Quality improvement