Download Speech and Language Therapy (Adults)

Bath and North East Somerset
Community Health and Care
Services:
Speech and Language Therapy
(Adults)
SD49
1.
Introduction
The service provides speech, language and swallowing services to community
patients, patients in the RUH and outpatients with head and neck cancer and with
voice problems.
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Purpose
To provide a timely response to adult community hospital inpatients requiring
swallowing assessments and intervention to reduce the rate of mortality (from
aspiration pneumonia; choking/airway obstruction), reducing morbidity (from
secondary infections; complications related to non-oral feeding, malnutrition,
dehydration, reduced access to oral medications), reducing acute hospital readmission, invasive procedures (unnecessary PEG feeding and tracheostomisation)
and length of stay (through optimisation of the healing process; facilitation of
discharge plans).
To provide a timely response to adult outpatients requiring swallowing assessments
and intervention to reduce the rate of mortality (from aspiration pneumonia;
choking/airway obstruction), reducing morbidity (from secondary infections;
complications related to non-oral feeding, malnutrition, dehydration, reduced access
to oral medications), reducing acute hospital admission and invasive procedures
(unnecessary PEG feeding and tracheostomisation).
To provide timely communication assessments to adult inpatients to promote
effective communication, enabling them to participate in decision making about their
care, reducing errors in care due to incomplete information, reducing patients’/their
carers’ level of frustration with the health care system and improving their overall
health outcomes during hospitalisation and after discharge.
To provide timely communication assessments to adult outpatients to promote
effective communication, enabling them to participate in decision making about their
care/activities of daily living and improving their overall health outcomes and quality
of life.
2.1 Aims and Objectives
Inpatient Objectives:
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Swallowing Inpatients (St Martin’s Hospital –Sulis/Older Person’s Unit; Paulton
Hospital)
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To provide initial clinical (bedside) swallowing assessments to all adult
inpatients within one working day of referral, in order to establish safe and
efficient nutrition and hydration methods and facilitate oral medication
administration. To assess patients’ ability to chew solid foods sufficiently to
prevent airway obstruction.
To provide objective video-fluoroscopic swallowing assessments to adult
inpatients and A&E attendees with questionable aetiologies, regardless of
their acuity.
To provide therapeutic strategies (e.g. texture modifications and positioning
suggestions) and interventions (e.g. oral exercises) to all adult inpatients with
swallowing problems.
To review and revise swallowing precautions/strategies, dietary modifications
and therapeutic interventions (e.g. every 2 days) regularly until discharge.
To facilitate service patients’/their carers’ improved understanding of their
condition (e.g. by showing them video footage of their own swallowing efforts)
and how to manage their swallowing problems.
Communication Inpatients (St Martin’s Hospital –Sulis/Older Person’s Unit; Paulton
Hospital)
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To provide communication assessments to all adult inpatients within one
working day (if urgent) and two working days of referral (if routine).
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To establish functional (verbal or non-verbal) communication of adult
inpatients regarding their medical symptoms, wishes (e.g. concerning medical
intervention or resuscitation) and care needs to relevant staff, carers and
family. This may be achieved through exercises or the use of specialised
augmentative devices.
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To provide regular (3-5 times weekly) speech and language rehabilitation to
inpatients with communication problems (excluding Older Person’s Unit).
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To train and supervise health care assistants in providing speech and
language rehabilitation to inpatients with communication problems.
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To act as interpreter on behalf of the patient, if required.
Outpatient Programmes:
Aphasia Group Outpatients (St Martin’s Hospital):
 To provide planning and clinical objectives/outcome measures for a weekly
peer- and volunteer-supported group therapy for patients with aphasia
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Parkinson’s Disease Outpatient Clinic (St Martin’s Hospital):
 To initiate communication and swallowing assessments immediately on
consultant referral in the Clara Cross Unit, with follow-up outpatient treatment
as requested by Parkinson’s Disease patients.
Older Person’s Programme (St Martin’s Hospital; Mental Health/Dementia):
 To provide assessments for outpatients with speech, language and
swallowing problems within 13 weeks of referral. To provide outpatient
rehabilitation to patients if clinically indicated and requested by patient.
General Outpatients (St Martin’s Hospital and Paulton Memorial Hospital):
 To provide assessments for outpatients with speech, language and
swallowing problems within 13 weeks of referral. To provide outpatient
rehabilitation to patients if clinically indicated and requested by patient.
3.
National/local context and Evidence base
Evidence base includes NICE guidance, guidance from Royal College and
Professional bodies, National Service Frameworks and National policies, standards
and guidance regarding best practice
4. Service Delivery
4.1
Service Model
The service is staffed by qualified, Health Professional Council registered Speech
and Language Therapists.
Referral Processes
Inpatient referrals are currently made in writing (referral forms or file notes) by
Community Hospital Physicians. Referrals from Speech Therapists from Acute
Hospitals/Multidisciplinary Teams are made by letter or verbal handover with
relevant documentation to follow by mail/fax.
Outpatient referrals from General Practitioners and Consultants are made in writing
(letters; fax referrals). Acute/Community Hospital/Multidisciplinary Team Speech
Therapists may provide verbal handover followed up by relevant documentation by
mail/fax. Outpatients may self-refer
Assessment and Treatment
Through comprehensive assessment, treatment and management, the service aims
to help people to continue their recovery or management, become more independent
and to adapt to life at home and within their local community.
Service users must consent to receiving involvement from the service and to the
interventions used.
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The service provides assessments for adult inpatients and outpatients who have
communication and/or swallowing problems. This will primarily include patients with
neurological diagnoses (MS, PD, Brain Injury, MND, and Stroke), Older
Person’s/Mental Health (Dementia) Respiratory conditions (aspiration pneumonia,
tracheostomy, COPD).
As part of their treatment and rehabilitation, patients are given oral exercises,
swallowing strategies and modification of their food consistency together with advice
about positioning while swallowing. They are provided with speech and language
exercises to improve communication. Carers are given information on how to
communicate with patients (e.g. post stroke).
The service works in a multidisciplinary way to maximise outcomes for the service
user, and to achieve greater flexibility, making best use of resources.
The service is a specialist resource for the organisation and provides advice, support
and education for other services (e.g. nursing teams) and carers as required.
Discharge processes
All inpatients seen by the Speech and Language Service are the responsibility of
Community Hospital Physicians. As such the discharge is their responsibility.
However, the service will write up a patient assessment form and make
recommendations for discharge when the patient is ready.
Outpatient discharges are made in collaboration with patients when clinical
outcomes have been achieved or patients refuse further treatment. Discharge
summaries are sent to the GP, Consultants, dieticians and any other identified health
or social care professional involved and to the patient on request.
4.2
Service Development – Opportunities and Issues to be addressed
To be developed
5.
Whole system relationships and interdependencies
The Speech Therapy Service provide communication and swallowing assessment
and therapy services to many community-based programmes. General Practitioners
are informed of the patients ongoing needs (e.g. patients’ need for
specialised/texture modified diets) on discharge.
Both Community Hospital Inpatient Services and Outpatient Services depend on
Radiology Services at the Royal United Hospital for objective instrumental videofluoroscopic swallowing assessments (VSFs). The Community Speech Therapists
liaise with the following professionals to collect information during the patient
assessment and to provide information about appropriate management: physicians,
nurses, dieticians, physiotherapists and occupational therapists.
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Inpatient Community Hospital Service users are referred by Community Hospital
Physicians and through discharge from Acute Hospital based Speech and Language
Therapists.
Outpatients may be referred by: General Practitioners and Consultants; Speech
Therapists from Acute Hospitals/Community Hospitals/Multidisciplinary teams (e.g.
Community Stroke Service Team, the Community Neurology Team); other
professionals and through self-referral. General Practitioners are informed of the
patients ongoing needs (e.g. patients’ need for specialised/texture modified diets) on
discharge.
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