Simulation to improve healthcare pathway and inequities for people with disabilities.
Authors: Espegren Olga 
Published: January 2024

Introduction: The Convention on the Rights of People with Disabilities (1) reported that people with disabilities do not have equitable access to health services. People with intellectual disabilities, especially the ageing, are more susceptible to somatic disease and other lifestyle diseases than the general population (2, 3, 4, 5, 6).
General practitioners' (GP) competence in the field of intellectual disability is largely experience-based, not systematic and research-based (7). In municipalities, approximately half of healthcare workers (HCWs) at municipal housing for people with intellectual disabilities are unskilled. These HCWs have experienced not being taken seriously when calling either their patients’ GP or accident and emergency (A&E) department to report that the resident is 'not well', resulting in residents receiving inadequate healthcare. Municipal leaders and educators decided to address the inadequate clinical observation and communication skills among HCWs with a simulation-based training program (SBTP), to improve competence and treatment of residents when escalating levels of care.
Methods: Based on national recommendations about ""Early detection of deteriorating condition"" and the urgency of the covid-pandemic, the SBTP was quickly rolled out to all HCW. The SBTP consisted of both theoretical teaching and e-learning in ABCDE, training in the tool NEWS2, as well as the communication technique ISBAR. Baseline NEWS2 scores were established for all residents.
Based on positive experience with SBTP in donning and doffing of personal protection equipment (8) in the municipality early in the pandemic, and uncertainty about safer care for sick corona patients in residential homes, leaders requested continued use SMTP to improve observational skills.
Results & Discussion: Evidence of improved competency at work and resulting improved escalation of care came fast.
One example was of a resident with backpain whose relatives’ recommended painkillers. HCWs performed NEWS2 scoring, discovered pathological changes, contacted A&E, received treatment advice, continually followed up on NEWS2 measurements, secured ambulance help & reaction based on baseline NEWS2, and admission where sepsis was discovered. Similarly, another group of HCWs performed NEWS2 scoring on a patient with presenting manic symptoms, discovered clinical signs of somatic illness, which lead to a completely different medication than expected. These cases were seen as post-SBTP improvements in HCWs behavior, and patient safety.

SBTP to improve observational skills in the municipality has led to better differential diagnosis in the early stage, more precise communication with GP and A&E which in turn has led to better healthcare pathways for a vulnerable patient group.
Keywords: simulation, observational competence, competence, health rights
References:
1) Convention on the Rights of People with Disabilities
2) Sutherland et al(2002): Health issues for adults with developmental disability.
3) Hermans et al(2014). Multimorbidity in older adults with intellectual disabilities.
4) Kinnear et al (2018). Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome.
5) O’Leary et al(2018). Early death and causes of death of people with intellectual disabilities.
6) Sandberget al (2015). Patterns of somatic diagnoses in older people with intellectual disability.
7) Fredheim, T. (2013). Intellectual disability and mental health problems:

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