ACQ Vol 10 No 2 2008

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ACQuiring knowledge in speech , language and hearing, Volume 10, Number 2 2008 51
Work– l i f e balance : preserv i ng your soul
Method
Setting
A weekend speech pathology service was established at JHH
Newcastle, New South Wales (NSW) in November 2001. The
JHH is the principle referral centre, teaching hospital and a
community hospital for Newcastle and Lake Macquarie, NSW,
Australia. It is the only trauma centre in NSW outside Sydney
and has the busiest emergency department in the state
(Hunter New England Health, 2005).
John Hunter Hospital contains 550 beds with specialities
including anaesthesia and intensive care, emergency medicine,
respiratory medicine, cardiology, cardiac surgery, neurology,
neurosurgery, head and neck surgery, endocrinology, kidney
transplants, nephrology and gastroenterology. The speech
pathology department employs 5.5 full-time equivalent (FTE)
clinicians to service a diverse inpatient and outpatient adult
caseload. The department has trained specialists in areas in­
cluding dysphagia, modified barium swallow, laryngectomy,
tracheostomy, voice and progressive neurological diseases.
The aim of the weekend service was to reduce the length of
time patients were kept nil by mouth or maintained on modi­
fied diets over the weekend period. Speech pathologists within
the department felt reluctant to upgrade patient diets on
Fridays due to concerns regarding aspiration risk with no
speech pathology review over the weekend. It was also a
concern that patients who were nil by mouth were less likely
to receive their medications and nutrition over the weekend
period.
Referrals to weekend service
Weekend speech pathology services are provided from 9 a.m.
to 1 p.m. on both Saturday and Sunday. New referrals to the
weekend service can be made electronically via page or
verbally between 9 a.m. and 12.30 p.m. on Saturday and
Sunday. Referrals received after 12.30 p.m. may be held over
until the next working day unless time permits. Referrals
received after 4 p.m. on Friday may also be referred to the
weekend service. Current inpatients on the speech pathology
caseload are referred to the weekend service by 4 p.m. each
Friday by their treating speech pathologist. The treating
speech pathologist completes a weekend referral form
(Appendix A) including suggested services required and
attaches the patient’s database form (Appendix B).
Staffing
A grade 1 speech pathologist was recruited permanently in
November 2001 to commence the weekend service to provide
four hours service on both Saturday and Sunday. The speech
pathologist is typically rostered to work additional part-time
Keywords:
speech pathology,
Dysphagia,
weekend service
No single clinical sign or symptom can predict the risk for
developi ng aspi rat ion pneumon ia but speech
pathologists can accurately identify patients with possible
dysphagia (Chan, Phoon & Yeoh, 2004). Bedside examinations
in the stroke population have 80 percent sensitivity
(Eisenberg & Kamerow, 1999). Early intervention optimises
recovery from stroke and even if swallowing problems are
not clinically apparent, a speech pathologist should be
consulted to avoid aspiration pneumonia and malnutrition
(Eisenberg & Kamerow). Dysphagia can lead to dehydration,
aspiration pneumonia and malnutrition, as well as depression
and deterioration in quality of life (Chan et al., 2004).
Therefore early management of dysphagia is important. If the
patient is unable to eat adequate amounts to maintain a
healthy weight, then malnutrition may occur which can
weaken the immune system resulting in susceptibility to
illness (Eisenberg & Kamerow). The evidence for early speech
pathology intervention with people with possible dysphagia
provides support for extending speech pathology service
provision to include weekends.
Tomolo (2006) reported a four-month pilot study on a
newly established weekend speech pathology service at the
Royal Melbourne Hospital (RMH), Victoria. This study
reported workload statistics and perceptions of speech
pathologists, nursing and medical staff regarding weekend
speech pathology services. Findings included improved
quality of care and minimisation of patient risk. The RMH
pilot study documented a reduced number of nasogastric
tubes inserted, reduced nil by mouth status, and the
prevention of unsafe oral feeding following implementation
of a weekend service. Tomolo also highlighted a paucity of
evidence regarding benefits of weekend allied health
services, specifically no published articles related to weekend
speech pathology services. Thus, although intuitively,
weekend speech pathology services appear to be worthwhile,
there is a limited objective evidence base to them. The aim of
the current paper is to contribute to the evidence base
regarding weekend speech pathology services by describing
the weekend speech pathology service at John Hunter
Hospital (JHH) and presenting data pertaining to this service
provision through a retrospective data audit. This paper
could be a useful reference for other services planning to
establish a weekend speech pathology service.
Weekend Speech Pathology Services
Wendy M. Archer and Anne E. Vertigan
Early speech pathology intervention offered to patients with acute dysphagia
aims to minimise risk of aspiration and dehydration. Further, early
administration of medications may result in earlier medical stabilisation,
improved patient outcomes and shorter hospitalisation. However, access to
speech pathology management of dysphagia can be problematic on weekends. A
weekend speech pathology service commenced in 2001 at the John Hunter
Hospital Newcastle, Australia. This service is described and data pertaining to
referrals and service provision is presented. The high success of this service is
demonstrated over a six-year period. This paper may provide other acute
hospitals with information and recommendations to consider when planning a
weekend service.
Anne Vertigan Wendy Archer