ACQ Vol 10 No 2 2008

Work– l i f e balance : preserv i ng your soul

W eekend S peech P athology S ervices

Wendy M. Archer and Anne E. Vertigan

Early speech pathology intervention offered to patients with acute dysphagia aims to minimise risk of aspiration and dehydration. Further, early administration of medications may result in earlier medical stabilisation, improved patient outcomes and shorter hospitalisation. However, access to speech pathology management of dysphagia can be problematic on weekends. A weekend speech pathology service commenced in 2001 at the John Hunter Hospital Newcastle, Australia. This service is described and data pertaining to referrals and service provision is presented. The high success of this service is demonstrated over a six-year period. This paper may provide other acute hospitals with information and recommendations to consider when planning a weekend service.

Wendy Archer

Anne Vertigan

Method Setting

Keywords:

speech pathology, Dysphagia, weekend service

A weekend speech pathology service was established at JHH Newcastle, New South Wales (NSW) in November 2001. The JHH is the principle referral centre, teaching hospital and a community hospital for Newcastle and Lake Macquarie, NSW, Australia. It is the only trauma centre in NSW outside Sydney and has the busiest emergency department in the state (Hunter New England Health, 2005). John Hunter Hospital contains 550 beds with specialities including anaesthesia and intensive care, emergency medicine, respiratory medicine, cardiology, cardiac surgery, neurology, neurosurgery, head and neck surgery, endocrinology, kidney transplants, nephrology and gastroenterology. The speech pathology department employs 5.5 full-time equivalent (FTE) clinicians to service a diverse inpatient and outpatient adult caseload. The department has trained specialists in areas in­ cluding dysphagia, modified barium swallow, laryngectomy, tracheostomy, voice and progressive neurological diseases. The aim of the weekend service was to reduce the length of time patients were kept nil by mouth or maintained on modi­ fied diets over the weekend period. Speech pathologists within the department felt reluctant to upgrade patient diets on Fridays due to concerns regarding aspiration risk with no speech pathology review over the weekend. It was also a concern that patients who were nil by mouth were less likely to receive their medications and nutrition over the weekend period. Referrals to weekend service Weekend speech pathology services are provided from 9 a.m. to 1 p.m. on both Saturday and Sunday. New referrals to the weekend service can be made electronically via page or verbally between 9 a.m. and 12.30 p.m. on Saturday and Sunday. Referrals received after 12.30 p.m. may be held over until the next working day unless time permits. Referrals received after 4 p.m. on Friday may also be referred to the weekend service. Current inpatients on the speech pathology caseload are referred to the weekend service by 4 p.m. each Friday by their treating speech pathologist. The treating speech pathologist completes a weekend referral form (Appendix A) including suggested services required and attaches the patient’s database form (Appendix B). Staffing A grade 1 speech pathologist was recruited permanently in November 2001 to commence the weekend service to provide four hours service on both Saturday and Sunday. The speech pathologist is typically rostered to work additional part-time

N o single clinical sign or symptom can predict the risk for developi ng aspi rat ion pneumon ia but speech pathologists can accurately identify patients with possible dysphagia (Chan, Phoon & Yeoh, 2004). Bedside examinations in the stroke population have 80 percent sensitivity (Eisenberg & Kamerow, 1999). Early intervention optimises recovery from stroke and even if swallowing problems are not clinically apparent, a speech pathologist should be consulted to avoid aspiration pneumonia and malnutrition (Eisenberg & Kamerow). Dysphagia can lead to dehydration, aspiration pneumonia and malnutrition, as well as depression and deterioration in quality of life (Chan et al., 2004). Therefore early management of dysphagia is important. If the patient is unable to eat adequate amounts to maintain a healthy weight, then malnutrition may occur which can weaken the immune system resulting in susceptibility to illness (Eisenberg & Kamerow). The evidence for early speech pathology intervention with people with possible dysphagia provides support for extending speech pathology service provision to include weekends. Tomolo (2006) reported a four-month pilot study on a newly established weekend speech pathology service at the Royal Melbourne Hospital (RMH), Victoria. This study reported workload statistics and perceptions of speech pathologists, nursing and medical staff regarding weekend speech pathology services. Findings included improved quality of care and minimisation of patient risk. The RMH pilot study documented a reduced number of nasogastric tubes inserted, reduced nil by mouth status, and the prevention of unsafe oral feeding following implementation of a weekend service. Tomolo also highlighted a paucity of evidence regarding benefits of weekend allied health services, specifically no published articles related to weekend speech pathology services. Thus, although intuitively, weekend speech pathology services appear to be worthwhile, there is a limited objective evidence base to them. The aim of the current paper is to contribute to the evidence base regarding weekend speech pathology services by describing the weekend speech pathology service at John Hunter Hospital (JHH) and presenting data pertaining to this service provision through a retrospective data audit. This paper could be a useful reference for other services planning to establish a weekend speech pathology service.

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ACQ uiring knowledge in speech , language and hearing , Volume 10, Number 2 2008