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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. 2 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: 2 Swallowing Inpatients (St Martin’s Hospital –Sulis/Older Person’s Unit; Paulton Hospital) 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) To provide communication assessments to all adult inpatients within one working day (if urgent) and two working days of referral (if routine). 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. To provide regular (3-5 times weekly) speech and language rehabilitation to inpatients with communication problems (excluding Older Person’s Unit). To train and supervise health care assistants in providing speech and language rehabilitation to inpatients with communication problems. 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 3 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. 4 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. 5 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. 6