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Case Studies

Drew is a 26-year-old Aboriginal male with intellectual disability and cerebral palsy who lives with his parents in rural NSW. He has a nasogastric tube in situ for formula and medication.

He aspirated his formula while in respite care and was admitted to hospital with aspiration pneumonia.

There had been previous discussions with family about a gastrostomy tube, but it was later found not to be possible, due to Drew’s severe kyphosis. His family was never keen on the idea.

Nasogastric tubes are not the preferred long-term mode of feeding due to the risks involved. For Drew, they were often dislodged. As he lives in a rural area Drew by-passes the local hospital to attend the base hospital for replacement of his tube. There is no care coordinator to advocate for Drew, develop a pathway to care which could bypass the emergency department, or book regular appointments. Insertion requires a radiologist and having the correct tube available. This often means Drew is hospitalised for the weekend, kept hydrated with an intravenous infusion and waits for the tube or the radiologist to be available.

The hospital discharge planner identified issues around ongoing care and unmet needs. They were able to find and articulate a clear pathway through the health system which incorporated a multidisciplinary approach to care planning. Drew and his family were at the centre of discussions and were supported by the aboriginal health worker. The hospital discharge planner became the key contact for Drew within the health service.

You can read more discharge from hospital case studies

Harry (45) lives in disability supported accommodation. He has intellectual disability, mental health concerns and needs communication support. Harry has an ingrown and infected toenail which will require a medical procedure. He is afraid of being in hospital with people he does not know, especially as his past visits to hospital were not pleasant experiences.

The staff at Harry’s supported accommodation house are not sure about the health system and Harry’s health needs. Harry does not have a regular general practitioner, but staff, after some effort, were able to get referrals to appropriate health specialists.

Eventually Harry receives a letter to attend a clinic.

Health staff in the clinic are unfamiliar with working with people with intellectual disability and their lack of confidence and communication skills unnerves Harry. He becomes anxious and wants to go home. In the confusion of the moment, there is no time for health staff to assess Harry’s needs around communication support, mental health and intellectual disability support.

There is no opportunity for health staff to explore ways in which Harry’s needs could be managed. Security staff are called to contain the situation as Harry becomes more frightened and his behaviour escalates. Staff are unsure what to do. They do not know where to access support and decide they are not trained to care for people with intellectual disability.

Harry returns to his supported accommodation without being assessed. He refuses to consider attending the next clinic appointment.

The supported accommodation staff are reluctant to be involved with the next clinic appointment after this experience and all their efforts which did not help in the end.

Harry’s toenail becomes septic and he becomes very unwell. Support staff call an ambulance and Harry is admitted to the local hospital’s emergency department. He remembers his previous experience and becomes very anxious again. The staff remember Harry from his previous visits and avoid caring for him as they lack confidence in their skills.

Harry stays in hospital for six weeks while he receives treatment. This is much longer than expected.

Mei (48) lives in disability supported accommodation, she has intellectual disability, mental health concerns and needs communication support. Mei requires a medical procedure. For Mei this means using visual aids and social stories. Previously, Mei has needed an anaesthetic for medical procedures to ensure her fear and anxiety do not prevent effective assessment and intervention. She is afraid of being in hospital with people she does not know.

The team leader at Mei’s accommodation saw it as her role to make sure she understood enough about the health system so she could advocate for Mei’s health needs. It took months for Mei to agree to see a general practitioner so she could get referrals to appropriate health specialists for gynaecological and dental reviews.

Mei’s regular general practitioner and her accommodation team leader were able to identify a hospital that could support Mei and her specific needs. A pre-admission planning case conference was arranged at the hospital and accommodation staff prepared Mei for this using a social story book.

Mei’s team leader and the health staff are committed to working together with Mei so she can be treated. They meet to understand Mei’s additional needs around communication support, mental health and intellectual disability support. They explore together how to best support Mei while she is an inpatient. They agree to visit her and encourage her to drink after her surgery. Because Mei needs two procedures, the hospital staff suggest that Mei is booked to have both procedures at the same time, while under anaesthetic.

Mei is prepared as an inpatient the day prior to her procedures. Her support staff are given the likely time of medical rounds so they can see medical staff to ask any questions.

Everything went to plan, and Mei did not stay in hospital longer than expected. A comprehensive discharge summary was provided to her support staff and general practitioner who provides routine follow up care. Group home staff report no adverse impact on Mei’s mental health after her hospital stay.

George (57) has intellectual disability and is coming into hospital for a hernia repair.

TThe health service process for achieving this outcome includes the following:

George's reported experience: 'I was able to go to hospital like everybody else'.