Abstract TP346: Implementation of a Tele-Swallow Safety Study

Abstract

Background: Small or remote hospitals are often underserved by Speech Language Pathologists (SLP) for dysphagia evaluation of acute stroke patients. Telehealth is being used for an increasing range of services, but there is limited experience in using this technology for Teleswallow evaluations. Objective: We describe barriers and potential solutions to implementation of an SLP Teleswallow program in the setting of an ongoing feasibility and safety study of 120 acute stroke patients. Methods: A team of 5 SLP’s with 3 to 33 years of stroke care experience, SLP Manager, a Telestroke Neurologist, and a data analyst, reviewed the literature to design this study. SLP’s trained on the Telehealth device. We standardized dysphagia evaluation using commercial texture products. Stroke patients are consented and randomized to Bedside vs Tele evaluation first. Patients then have the other evaluation by a second, blinded SLP. The Teleswallow SLP directs remote RN or CNA assistants, who have varying exposure to the Tele device and to swallow evaluations. SLP’s provided feedback on using the Tele device and on evaluating patients remotely. Findings: SLP’s describe patient, logistic, and professional challenges to Teleswallow. Patient issues were receptivity to Tele technology, language deficits and facial hair. Logistic issues were getting Tele device and study food to the room, device position for best view/lighting, and coordinating schedules for control station, patient, and RN. Professional issues were orienting remote RN, and RN interference with evaluation by cuing the patients. SLP’s report a rapid learning curve in Tele device use, and in how to interact with remote patients and staff. Experience clearly enhanced comfort and efficiency, and likely improved reliability of evaluation. They found that visual and auditory experience with Teleswallow is similar to bedside evaluation, including in patients with aphasia. Conclusions: SLP satisfaction with Teleswallow technology and working with remote patients and RNs improved with experience. Implementation of Teleswallow evaluation was straightforward and feasible. Training with 4-5 mock patients and RN’s may enhance comfort with the process. Safety will be reported at conclusion of the study.