Risk assessment tool in acute hospitals reported to contribute to improvement in health outcomes for people with learning disabilities


We recently posted about the publication of the final report of the confidential inquiry into premature deaths in people with learning disabilities.

The Inquiry found 43% of the deaths of people with learning disabilities were unexpected and for a substantial number, there was significant difficulty or delay in diagnosis, investigation or specialist referral.

The Inquiry concluded that there was a need for substantially improved identification of  people with learning disabilities in healthcare settings and better implementation of reasonable adjustments to avoid their serious disadvantage.

The researchers in this study were keen on one key area which is poorly explored in the literature at present – the approach in acute hospitals to risk assessment for this patient group. They set out to report the outcomes of a patient safety project conducted in an NHS Trust acute hospital by the learning disabilities team.

What they did was create a project, supported by the Trust’s patient safety team working with the National Institute for Innovation and Improvement: leading improvement in patient safety (LIPS) programme, which is an NHS programme designed to help build capacity and capability within hospital teams to improve patient safety.

The project set out to bring together current evidence, to understand the risk issues associated with people with learning disabilities in acute hospital settings and to develop a robust risk assessment tool which could be used in the day to day care processes currently in operation in the acute hospitals of the Trust.

They piloted a short risk assessment process for six months, and what they found was that a short assessment in a format familiar to acute care nurses was likely to be used by nurses.

They also found that risk assessment on its own did not deliver better and safer care. They suggest that this must be accompanied by “a series of clear, evidence based actions that used together ensure the patients’ total safety and care needs are met.”

The risk assessment tool has been adopted for use throughout the Trust and other hospitals in the region and the authors believe is use is a contributory factor to the reduction of length of stay and an improvement in health outcomes for people with learning disabilities, but they point out that what the project has identified is the complex nature of introducing new systems and processes into NHS services and  the need for more work to gather data on impact.

They suggest their study adds to the understanding of the complexities of risk for patients with learning disabilities in acute hospital settings and they call for further education to underpin new assessment tools in clinical practice.
Rapid risk assessment in acute hospital for patients with intellectual disabilities, Read S & Johnson T in Advances in Mental Health and Intellectual Disabilities, 6 6, 321 – 332

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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