JCPSLP Vol 21 No 3 2019

on Safety and Quality in Health Care, 2018). The ABS Adult Literacy & Life Skills Survey (2008) found that 59% of Australians are functionally health illiterate. Health literacy is not a static measure; it is not visible or easily measurable in any health care interaction. Research has demonstrated that health care providers are poor at predicting patient health literacy (Hadden, 2015). A universal precautions approach to health literacy assumes that all patients have difficulty understanding health information and puts into place strategies that enhance understanding of health information for all (Agency for Healthcare Research and Quality [AHRQ], 2010). Use of universal precautions toolkits can enhance all patients’ understanding of health information (AHRQ, 2010). At Bendigo Health, speech-language pathologists (SLP) provide assessment and management of communication impairment, and its effect on communication activity. Their role in hospitals includes identifying and addressing the frequent communication issues faced by patients. Patients with a newly acquired disability related to medical admission are routinely identified and referred. However, patients that have a pre-existing communication disability, undiagnosed communication impairment, or those who are experiencing temporary communication difficulties due to medical conditions can go undetected. This study aimed to determine the prevalence of patients requiring assistance to successfully participate in health communication in an inpatient health care setting. Currently there are no mechanisms in place to report communication breakdown as a cause or contributing factor to any reported incident. The data obtained from this research is intended to inform SLPs and the broader organisation in considering priorities for quality improvement projects. Method A low-risk ethics study proposal was submitted to and approved by Bendigo Health and Human Research Ethics Committee (HREC). A waiver of consent for participation in this study was granted by the HREC. The task of understanding and consenting to the low-risk research was problematic as the identification of communication disability was the study’s aim. Assessing communication ability is considered standard practice for SLPs in the provision of care. Verbal or non-verbal assent was obtained as is the case for any clinical encounter. Design A cross-sectional study was conducted using a validated screening tool. The communication disability screener (CDS) was selected as a measure communication activity limitation for patients in the health care setting (O’Halloran, 2012). The CDS is a semi-structured interview based on the inpatient functional communication interview (IFCI). Psychometric investigation of the IFCI showed that it is a valid and reliable measure of a patient’s ability to communicate health care needs in hospital (O’Halloran, Worral, & Hickson, 2007). The criteria for items selected in the CDS from the IFCI required them to measure a patient’s ability to communicate health care needs and to be sensitive enough to identify those patients having difficulty (O’Halloran, 2012). The six items used in the CDS included: telling what had happened to bring them in to hospital, understanding the reason for admission, understanding the implications of the reason for admission, describing what hospital procedures were required (immediate recall), following instructions and recalling what procedures were planned (delayed recall). A supportive communication environment was provided

allowing clarification as in any interaction. Any required visual and hearing aids were provided. Participants All inpatients on the geriatric evaluation and management (GEM) rehabilitation unit and the acute medical ward at Bendigo Health in Victoria were eligible to be screened. Bendigo Health is a regional health service with a catchment covering a quarter of the state. Patients admitted to the GEM service were over 65, and had no significant acute medical condition with predetermined assessment or rehabilitation goals. Admission diagnosis to the acute medical ward showed 71% of patients had an acute medical condition, 10% neurological, 10% cognitive change and the remainder orthopaedic or functional decline. A waiver of consent was granted due to the practicality of gaining consent where communication impairment is prevalent. All patients were approached as per normal clinical practice. Verbal or non-verbal refusal of communication screening was honoured. Administration of the CDS was conducted on all available patients admitted on a single calendar day for each ward. Procedures The CDS was administered as per the administration and scoring of the CDS manual. It was used with permission of the author. The CDS was administered by three speech pathologists employed at Bendigo Health and four final-year SLP students. All SLPs were familiar with the CDS, ensuring adherence to its administration guidelines. SLP students attended an additional 90-minute tutorial to establish understanding of the tool, correct procedural administration, and interrater reliability. Students using the CDS were under the direct supervision of SLPs. Results of the CDS were documented in the individual patient history for clinical management purposes. Patients who required further communication assessment and management were referred to speech-language pathologists Data analysis The data was collated using of Excel. Frequency distribution for each variable is presented in numbers and percentages. Due to limited number of participants, inferential statistics were not completed. Results The results of this study showed that 33.3% of patients admitted to the acute medical ward and 53.6% of patients admitted to the GEM ward were able to independently communicate about their health care needs as measured by the CDS. This study also showed 66.7% of acute medical and 46.4% of GEM patients would not be able to effectively communicate without specialist assistance or support (see Table 1).

Table 1. Ability to independently communicate health care needs as measured by the CDS

Referral to speech- language pathology n (%)

Able n (%)

Unable n (%)

Total screened n (%)

Acute

16 (33.3)

32 (66.7)

48 (100)

17 (35.4)

GEM 15 (53.6)

13 (46.4)

28 (100)

12 (42.9)

Total

31 (40.8)

45 (59.2)

76 (100)

29 (38.2)

150

JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology