Column
The safety of people admitted to New Zealand hospitals has featured prominently in the media this year. Many times the issues that are reported relate to particular errors, either by clinicians or by the ‘system’ (for example, waiting list management at Whanganui Hospital or Grey Hospital). Early in the year, the Government appointed Health Quality Improvement Committee reported for the first time on 182 sentinel events relating to medical errors in 21 District Health Boards that put patients at unnecessary risk. While this approach has been criticised in the medical press for potentially encouraging clinicians to not report mistakes, there has been little or no mention of the safety of hospitals for people with disabilities.
This is important for a number of reasons.
People with disabilities have greater health care needs than people without disabilities. This can relate to the primary reason for being disabled, but it is also likely that people with disabilities have more comorbidities (other health problems), are socioeconomically more deprived, less likely to participate in wellness screening practices and are less able to exercise regularly. As a consequence, many people with disabilities are regular users of hospital services and are exposed to a greater extent to the possibilities of poor practice or systems failure.
Generalist hospital staff are poorly trained in the management of people with complex disabilities. This may be due to lack of exposure during training because of the rarity of individual health conditions (although collectively rare conditions make up a significant number of affected people in New Zealand). But my perception is that the undergraduate medical and nursing students receive little teaching in rehabilitation and disability management during their courses. This may also colour their attitudes to people with disabilities, so that their lack of knowledge is compounded by potentially negative attitudes.
Loss of control during a hospital admission is the common experience of most patients, but this can be especially frightening for people with complex disabilities who may have taken some years to achieve a support network that works for them. The hospital environment does not typically replicate this support network, and the experience of admission can be highly dis-empowering and sometimes threatening for some people.
Professor Peter Davis has been awarded $1.7M in the latest funding round of the Health Research Council to investigate health systems performance in order to enhance hospital outcomes. His team have previously conducted an important study “The New Zealand Quality of Healthcare Study”. In an analysis of patient deaths associated with reported adverse events, patients tended to be older with many comorbidities (Briant et al, 2006). Although, pre-morbid disability was not specifically assessed in these studies, it seems likely that such patients are more likely to have had some level of disability prior to their hospital admission.
It would be tremendous to see such research to have at least some focus on people with disabilities. It is also about time that health profession undergraduate curricula incorporate teaching about people with disabilities and I would urge all hospital-based practitioners to support the work of their DHB’s Disability Advocate in promoting the right attitudes and to help their colleagues to meet the needs of people with disabilities who are admitted to hospital.
Assoc. Prof Will Taylor PhD, MBChB, FAFRM FRACP
NZRA President
president@rehabilitation.org.nz
Head of Rehabilitation Teaching & Research Unit, University of Otago, Wellington
Will Taylor
