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Lal PB, Ward EC, Wishart LR, Schwarz M, Seabrook M, Coccetti A. Nature and timeliness of dysphagia management within an emergency setting. Int J Speech Lang Pathol 2024; 26:233-243. [PMID: 37306536 DOI: 10.1080/17549507.2023.2210266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine referral pathways, clinical demographics, and timeliness of dysphagia management within an emergency department (ED) setting utilising both ED staff and speech-language pathology (SLP) initiated referral pathways. METHOD Six-month retrospective service review of patients who received dysphagia assessment by SLP within a major Australian ED. Data were collected on demographics, referral information, and SLP assessment and service outcomes. RESULT Three hundred and ninety-three patients were assessed by SLP staff in the ED, consisting of 200 stroke and 193 non-stroke referrals. In the stroke cohort, 57.5% of referrals were initiated by ED staff, while 42.5% were SLP initiated. ED staff initiated 91% of non-stroke referrals, with few (9%) proactively identified by SLP staff. SLP staff identified a higher proportion of non-stroke patients within 4 hr of presentation compared to ED staff. Stroke patients identified by SLP staff were more likely to have assessments completed within 8 hr compared to the ED referral pathway. Collectively, 51% of patients required ongoing dysphagia management following initial assessment. CONCLUSION Findings provide an overview of SLP services and referral pathways in an ED context. The SLP initiated referral pathway facilitated early assessment of stroke patients, and collaboration with ED staff was integral in referring other at risk populations. SLP/ED synergy is needed for appropriate and timely dysphagia management practices in an ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
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Lal PB, Ward EC, Wishart LR, Foley J, Schwarz M, Seabrook M, O'Donnell C, Coccetti A. Dysphagia Management in the Emergency Department: Using Concept Mapping to Identify Actionable Change to Improve Services. Dysphagia 2024:10.1007/s00455-023-10651-5. [PMID: 38206345 DOI: 10.1007/s00455-023-10651-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Integrated speech-language pathology (SLP) services within the emergency department (ED) may facilitate timely dysphagia management. However, there are multiple patient and logistical factors specific to the ED that challenge the delivery of optimal dysphagia referral and management practices within this setting. The aim of the current study was to engage a stakeholder group to identify prioritised, actionable goals that could help enhance dysphagia management within the ED. METHODS AND PROCEDURES Applying concept mapping methodology, 16 ED stakeholders from SLP, medical, nursing, and leadership participated in semi-structured interviews to develop action statements which were sorted and ranked for importance and changeability. Multidimensional scaling and hierarchical cluster analysis were used to organise data in clusters with unifying themes before statements were ranked by importance and changeability. OUTCOMES AND RESULTS Stakeholders identified 53 unique statements, grouped into 8 clusters. Review of the 8 clusters identified 3 overarching aspects for change: (a) Improving processes related to identification and referral of patients as well as communication; (b) Teamwork and collaboration amongst the ED multidisciplinary team and SLP; and (c) Improving staffing and access to training resources for SLP and nursing teams. Seventeen statements were within the Go-zone rated highest for importance and changeability) with the highest rated statement being: Clear documentation by SLP re: recommendations. CONCLUSION The current data identified multiple aspects of service provision that require change to facilitate improved dysphagia referral and management services in the ED. Collaborative actions are required by both SLP and the ED multidisciplinary team to help optimise dysphagia services.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Buranda, QLD, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Buranda, QLD, Australia
| | - Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | | | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia
| | - Carolann O'Donnell
- Department of Emergency, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department. Int J Speech Lang Pathol 2023; 25:509-522. [PMID: 35579003 DOI: 10.1080/17549507.2022.2071465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. METHOD Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). RESULT SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. CONCLUSION There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding speech pathology and dysphagia service provision in Australian emergency departments. Speech, Language and Hearing 2020. [DOI: 10.1080/2050571x.2020.1833469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pranika B. Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Laurelie R. Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Maria Schwarz
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Coccetti
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
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