Improving the Documentation of Accessible Communication for Inpatients with Learning Disabilities in Geriatrics

Introduction 

People with learning disabilities (LDs) experience significant health inequalities and poorer health outcomes. Communication difficulties and failure to provide appropriate reasonable adjustments may contribute to avoidable harm. The Learning from Lives and Deaths (LeDeR) programme identifies communication and reasonable adjustments as areas requiring improvement. The NHS Accessible Information Standard (AIS) requires healthcare organisations to identify, record, flag, share, meet and review patients’ communication needs. This quality improvement project aimed to improve the documentation of communication needs and reasonable adjustments for inpatients with LDs admitted under Geriatric Medicine. 

Method 

Two retrospective audit cycles reviewed electronic patient records for patients with LDs admitted under Geriatric Medicine. Cycle 1 included admissions from December 2025 to March 2026 (n=21), followed by re-audit of admissions from April to June 2026 (n=25). Key AIS outcomes were assessed, including communication needs being flagged, reasonable adjustments documented, evidence of patient understanding, and communication needs shared at discharge. Following Cycle 1, a multidisciplinary teaching session was delivered to the Geriatric Medicine Team covering the national standard, Health Passports, the role of the Learning Disabilities Team, and documentation of communication needs and reasonable adjustments. 

Results 

Communication needs were flagged in 14.3% (3/21) of patients in Cycle 1 compared with 4% (1/25) in Cycle 2. Reasonable adjustments were documented in 9.5% (2/21) versus 4% (1/25), respectively. Clear documented evidence of patient understanding remained low (4.8% [1/21] vs 4% [1/25]). No patients in either cycle had communication needs documented in discharge summaries. 

Conclusion 

Documentation of communication needs and reasonable adjustments remained poor following the educational intervention. Documentation frequently reflected perceived communication ability rather than specifically assessed needs. These findings support that education alone is insufficient to achieve sustained improvement and that system-level interventions, such as standardised documentation templates, alongside ongoing staff education, may be required to improve adherence to the AIS.