Understanding speech pathology and dysphagia service provision in Australian emergency departments

Abstract

ABSTRACT Background: Early detection of dysphagia can reduce associated medical sequelae and subsequent burden of care. As most patients admitted to acute care services present first via the emergency department (ED), timely speech-language pathology (SLP) involvement in ED services may improve patient and service outcomes. To date, however, there is limited knowledge of the nature of current dysphagia management practices within EDs. Methods and procedures: A national online survey was utilized to explore SLP service provision, referral patterns, dysphagia assessment/management practices and perceptions of SLP services within the Australian ED setting. Respondents represented 68 clinical facilities across Australia. Outcomes and results: Almost all (97%) reported providing SLP-led dysphagia services in the ED, though occasions of service were low (<10 referrals per week). Additionally, 76% of services utilized nursing-led dysphagia screening. Dysphagia services were primarily focused on patients admitted post-stroke (84%), with clinical pathways reportedly less consistent for other clinical populations. Most respondents (95%) perceived the provision of SLP services in ED as valuable, however, identified funding and resource issues, limited recognition of the role of SLP in ED, and patient flow as key challenges to dysphagia service provision in EDs. Conclusions: This study highlights that current clinical models of ED dysphagia management are largely dependent on nursing-led screening which are predominantly only applied for patients admitted post-stroke. Further research into dysphagia risk identification beyond the stroke population is needed to determine optimal clinical service models for dysphagia management within the ED setting.