Introduction – Although they are a minority in the general population, people with intellectual disabilities visit the emergency department more frequently. They are a complex, vulnerable, heterogeneous population, and healthcare professionals in acute care settings are oftentimes not prepared to deal with this kind of patients. In order to palliate this problem, the Geneva University Hospital (HUG) has put into place a special unit for the admission of patients with disabilities, defining procedures to follow during admission, and a questionnaire specific to this population that can be filled by the accompanying person. On the other hand, the Lausanne University Hospital (CHUV) does not offer this solution. In this study, we will explore the reality health professionals in Lausanne's emergency department have to face when dealing with this kind of patients, as well as exploring what factors influence the quality of for this population.
Methodology – Following a literature review, we conducted a qualitative-style study by the means of six semi-structured interviews, and two focus groups. The data was anonymized and analysed in a thematic grid after transcription. Another literature review was conducted to complete the information that was brought up by the participants.
Results – The participants gave us an overview on existing resources, presented examples of difficult situations and the solutions that were found.
In Geneva, participants stated being more aware of the particularities of this population thanks to the existence of the Programme Handicap. Participants in both hospitals expressed the urge for more resources that can answer to their specific needs. Opportunities for pre- and post-graduate training are deemed insufficient to face the challenges that are encountered, which leads to worse quality of care for these patients.
At the same time, not only the communication between the patient and the healthcare professionals was deemed a determinant of the quality of care, but many more factors come into play, such as time, setting, and the collaboration between different actors. Caregivers are also extremely important in helping healthcare professionals interact with people with intellectual disabilities.
Discussion and conclusions – Our findings were coherent with data found in literature: health professionals lack information and adequate tools in order to properly care for people with intellectual deficiencies, which may result in more paraclinical exams and over-medication. Health professionals sometimes feel uncomfortable in dealing with such patients, and experience difficulties in communication, especially in the case of behavioural disorders.
There are many solutions that could be implemented to improve the quality of care and the communication between all parts involved, notably the adoption of the entrance questionnaire used in Geneva, creating a specialized unit in Lausanne, and improving training opportunities. Raising awareness about this people with intellectual disabilities, which would bring to more policies and research being written about this population, which could improve the quality of care and bring about change in the healthcare system. In Switzerland in particular, this topic is still under-represented in the medical world.
Improving quality of care for people with intellectual deficiencies would be important, because it would lead to the implementation of solution that would benefit other vulnerable populations.