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Quality Care in the Emergency Department for Individuals With Developmental Disabilities

Applied Health Research Question submitted to H-CARDD by Peel Crisis Capacity Network
Authors: Yona Lunsky, Johanna Lake & Jacques Lee

Background

Emergency department visits are a costly type of health care use. Preliminary evidence suggests that emergency department use by individuals with developmental disabilities is problematic for them along with hospital staff.

Purpose

The purposes of this report were to offer an overview of research on patterns and predictors of emergency department use among persons with developmental disabilities and to summarize what is known about the care received by individuals with developmental disabilities in the emergency department.

Methods

Qualitative and quantitative studies from Canada, the United States, the United Kingdom, Australia, and Taiwan were reviewed.

Results

  • The likelihood of emergency department visits was higher in individuals with developmental disabilities than those without, as were the average number of emergency department visits. Individuals with developmental disabilities visited the emergency department for both medical and psychiatric reasons.
  • Clinical variables associated with emergency department use among individuals with developmental disabilities included mild disability, behaviour problem, aggression, presence of a comorbid physical and mental health problems, life events, and medication use.
  • Demographic variables associated with emergency department use included lower neighbourhood income and residence with family (vs. group home or supported independent living).
  • Service variables associated with emergency department use included not having a family doctor, not have a crisis plan, previous emergency department use, and lack of involvement with the criminal justice system.
  • Emergency department care was suboptimal from the perspective of patients with developmental disabilities, caregivers, and emergency department staff. Care plans and patient tools may help to improve emergency department care for this population. Emergency department staff must be provided with training about patients with developmental disabilities (e.g., comorbidities, communication strategies, medication issues).

Conclusions and Implications

Emergency department use is common among adults with developmental disabilities, and there are a range of clinical, demographic, and service variables associated with use.  Emergency department use is problematic among individuals with developmental disabilities and their family members as well as emergency department staff, but little has been done to improve this situation. Interventions should be developed to improve emergency health care for adults with developmental disabilities.