Implementation of an extended scope of practice speech-language pathology allied health practitioner service: An evaluation of service impacts and outcomes

Abstract

With appropriate governance and risk management, an extended scope SLP AHP service for low risk dysphagia and dysphonia can achieve safe, effective and beneficial changes to ENT service delivery.

Outcomes of a multidisciplinary Ear, Nose and Throat Allied Health Primary Contact outpatient assessment service

“…Our findings on reduced wait-times and discharge without the need for surgical intervention are comparable with similar AHP-led services in fields including ENT, musculoskeletal, pelvic health and gastroenterology. 10,[12][13][14][15][16] The AHPC-ENT aimed to capture only patients suitable for AHP intervention without returning to ENT, supporting the "one-stop" approach. Most patients seen in the AHPC-ENT were managed by AHPs without a need for ENT intervention, although results differed across the 5 AHPC-ENT pathways.…”

“…In the dysphonia and dysphagia pathways, relatively few patients returned to ENT as also reported in similar models. 13,14 A small number of these patients required ENT priority assessment following the AHPC-ENT and were seen by ENT in less than 4 weeks. Earlier identification of patients for ENT medical or surgical intervention was another benefit of this model for patients initially categorised as a low acuity, who would otherwise have remained on the wait-list with untreated symptoms.…”

“…AHP expanded scope models can positively impact health care through streamlined access to the right treatment services, improved patient outcomes, patient satisfaction and cost benefits. 4,[10][11][12][13][14] Our study aimed to evaluate the impact of multiple AHP Primary Contact ENT (AHPC-ENT) pathways, including dysphagia, dysphonia, vestibular, retro-cochlear and paediatric glue ear by addressing these questions:…”

Expanding speech pathology delegation practices: engaging Allied Health Assistants (AHAs) in dysphagia management in the acute hospital setting

“…The impact of SP led FEES is noted to be positive, with a file audit comparison of stroke patients pre and post introduction of SP led FEES service indicating a reduced incidence in pneumonia and increased likelihood of returning to un-modified diet following introduction of the service (Bax, McFarlane, Green, & Miles, 2013). Independent completion of nasendoscopy by a trained and credentialed SP has also been evaluated in the context of completing voice and dysphagia assessments typically performed by an ENT physician, with this model demonstrating both wait list reductions for the ENT and excellent maintenance of patient safety (Seabrook, Schwarz, Ward, & Whitfield, 2018). Within this service the SP conducted independent nasendoscopy to determine swallow safety and severity of dysphagia (Seabrook et al, 2018) which is a growing example of extended practice within speech pathology.…”

“…Independent completion of nasendoscopy by a trained and credentialed SP has also been evaluated in the context of completing voice and dysphagia assessments typically performed by an ENT physician, with this model demonstrating both wait list reductions for the ENT and excellent maintenance of patient safety (Seabrook, Schwarz, Ward, & Whitfield, 2018). Within this service the SP conducted independent nasendoscopy to determine swallow safety and severity of dysphagia (Seabrook et al, 2018) which is a growing example of extended practice within speech pathology. The long-term impact of role enhancement however remains uncertain, particularly with regards to clinical outcomes of patients (Dubois & Singh, 2009).…”