Living with Disability Research Centre, La Trobe University, Bendigo, Vic., Australia.
Living with Disability Research Centre, La Trobe University, Melbourne, Vic., Australia.
J Intellect Disabil Res. 2020 May;64(5):357-367. doi: 10.1111/jir.12725. Epub 2020 Mar 16.
Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided.
A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study.
Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED, 85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days.
Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level.
先前的研究表明，智障人士在医院的体验较差，预后也较差。本研究的主要目的是前瞻性地跟踪澳大利亚医院智障成年人（ID）的住院情况，重点关注所提供护理质量的指标。
对 35 个月的医院记录进行前瞻性审核，得出了有关患者特征、住院次数和时长、诊断评估和结果、急诊科（ED）后去向和出院后建议的定量数据。50 名参与者主要通过在医院 ED 入口处的识别招募而来。在住院期间结束时，使用为该研究开发的工具对患者的医院记录进行审核。
参与者主要为男性（70%），平均年龄 42.9 岁，主要与家人（46%）或在支持性住宿（44%）中生活。在记录的 157 次住院中，96%从 ED 开始，85%需要紧急或半紧急护理，62%在研究参与的前 3 个月。ED 停留时间平均超过 4 小时的国家基准，40%的住院符合该基准。91%的住院进行了一次或多次诊断评估，其他则在短期住院病房进行。近一半（49%）导致住院。去除一个极端数据点后，在病房中停留的时间为 1-35 天。75%的住院中最常见的诊断是消化系统问题，其次是神经系统问题和伤害。住院时间中位数反映了澳大利亚精细诊断相关组的数据。发现高频率的住院再入院：总共 67%的住院，其中 26%（n=12）在 72 小时内，59%（n=23）在 30 天内。
智障成年人经常到 ED 就诊，且经常住院时间较长。我们没有发现医院工作人员愿意让患者留在 ED 并进行诊断评估方面存在护理实践不佳的迹象。然而，频繁的再入院表明在某种程度上医院护理失败。
