Prioritising a SALT caseload

The Royal College of Speech and Language Therapists provides guidance on prioritisation in their book on best practice; Communicating Quality 3 (RCSLT 2006). Prioritisation is a highly relevant topic in the NHS environment at present due to the streamlining of services and the demand for efficacy.

CQ3 states that:

1.     ‘a prioritisation policy should be formulated which defines a range of criteria upon which the decision to fulfil a duty of care will be made on a case by case basis’.

2.     ‘ The key factor in relation to prioritising an individual for therapeutic care is the judgement about the level of clinical risk’.

Recommended Prioritisation Criteria:

1.  Risk

·   Immediate health risks if the individual is not seen e.g. risk of penetration.

·   The risk of secondary complications if the individual is not seen e.g. aspiration pneumonia.

2    2.Timing

·   Optimal time for intervention to achieve maximum potential, e.g. there is evidence for improved health outcomes for people with long term neurological conditions  when they are seen early on in their pathway by a specialist.

·   Medical urgency e.g. rapidly deteriorating condition.

3   3. Wellbeing

·   Anxiety/distress/concern expressed by the individual, caregiver or family.

·   Effect of difficulties on the individuals communicative/ swallowing function in the current environment.

·   Effect of difficulties on participation in everyday activities/ quality of life.

4   4. Predicted outcome in current context

·   Individual/carers ability to engage with therapy.

·   Availability of SLT resources/ skilled support to help the individual maintain gains.

·   The individuals potential for change.

·   Response to previous SLT.

Ward Rounds

I've just read a joint report by the Royal College of Nursing and the Royal College of Physicians called: Ward rounds in Medicine: Principles for Best Practice (Published in October 2012). Here is my summary of the most important learning outcomes:

Medical Ward Rounds

1.     Opportunity for the multi-disciplinary team to come together to review the patients’ condition and develop a plan for care while facilitating the full engagement of the patient/carer in making decisions about their care.

2.     Opportunity for information sharing and joint learning.

Barriers/Challenges

1.     Communication - multiple teams may be responsible for a patients’ care, frequent staffing changes e.g. rotations, and frequent patient transfer between wards/teams may all have a detrimental effect on communication within the team.

2.     Ward rounds may be inadequately prioritized.

3.     The patient may need support (e.g. from a nurse/SLT) to articulate their views.

Recommendations for ward rounds

1.     A senior nurse should be present at every bedside patient review and nursing staff should be informed of all key decisions.

2.     Individual roles/responsibilities should be allocated at the start of ward round to engage all MDT members. Preparation for ward round should include a re-round briefing and the identification of staffing issues/ adverse factors relating to the patients.

3.     Patients should be encouraged to prepare in advance for ward rounds and patients/carers/relatives should be provided with a ‘summary sheet’ detailing information discussed in ward round.

4.     All members of the ward round team should be introduced to the patient.

5.     Board rounds – can facilitate MDT input and planning for discharge.