COMMDIS416 1st Edition Lecture 14Outline of Last LectureI. Caseload vs. Workload II. Impact of Large Caseloads III. Workload IV. Workload Analysis V. Approaches to Managing Existing Workloads VI. Scheduling Strategies VII. Massed vs. Distributed Practice VIII. Scheduling 101 Outline of Current Lecture I. SLP in Medical Settings II. Patient Demographic: Acute Care Setting III. SLP in Medical Settings IV. Collaboration with Other Disciplines V. Medical Documentation: Requirements VI. Guidelines for Entries in Progress Notes VII. SLP’s Responsibilities in Medical Settings VIII. Swallowing Disorders (Dysphagia)IX. What are the signs of a swallowing problem? X. Swallowing ManagementXI. What happens when we swallow? XII. Stages of Swallow XIII. Oral phase problems include: XIV. Pharyngeal Phase Problems include:XV. Esophageal Phase Problems include:XVI. Swallowing EvaluationXVII. Swallowing Concerns XVIII. Swallowing Evaluation XIX. Swallowing Diagnostics XX. Swallowing Evaluation XXI. Swallowing Diagnostics XXII. Pediatric Swallowing Disorders XXIII. Medical SLP Case Study: “The Marathon Man” Current Lecture<<Medical SLP>>I. SLP in Medical Settings - Work mainly in acute or subacute/post-acute care o Hospitals, rehabilitation facilities, outpatient clinics, long-term care and skills nursing facilities, private practice.o In the majority of medical settings, SLPS see patients only by referral.o SLPS usually require a written order from the patient’s physician in order to diagnose, treat, or screen patients.o In some settings, a physician’s assistant (PA), a nurse practitioner (NP) or advanced nurse practitioner (ANP) may also have privileges to write orders.II. Patient Demographics: Acute Care Setting - Age range of acute care patients:o 30-49 years: 11%o 50-59 years: 11%o 60-69 years: 17%o 70-79 years: 27%o 80 years and older: 30%- Top 5 primary medical diagnoses of acute care patients:o CVA: 35% (stroke)  swallowing o Respiratory diseases: 13%o Head injury: 6%o Hemorrhage/Injury: 5%o CNS diseases: 4%- Top 5 Functional Communication Measures scored by SLPs working in acute care:o Swallowing: 77%o Spoken Language Comprehension: 24%o Spoken Language Expression: 23%o Motor Speech: 19%o Memory: 13%- Average length of stay for acute care patients:o 11 days III. SLP in Medical Settings - SLPs in acute-care settings don't provide long-term management of communication or swallowing disorders. - Their goals are to help patients recover communications skills or swallowing functions asquickly as possible, and to lay the groundwork for longer-term therapy by other colleagues.- Assess communication, cognition, and swallowing status- Confirm or establish a diagnosis- Implement treatment to improve communication, cognition, and swallowing disorders resulting from diseases and other medical conditions. Common diagnoses requiring SLP orders:o L CVAo R CVAo TBIo Brain tumorso Parkinson’s diseaseo Encephalopathyo Hypoxia, anoxiao Multiple sclerosiso Amyotrophic lateral sclerosiso Myasthenia graviso Bell’s palsyo Dementiao Head and neck cancero Patient’s admitted with a tracho Voice disorders that are newly diagnosed – polyps, nodules, vocal fold paralysis- Some facilities have established "critical pathways" based on admitting diagnosis that may facilitate the referral process. - For example, a critical pathway for an individual admitted with a stroke may include an SLP consult within the first 24 hours for a swallowing evaluation. In this case, the consult is automatically entered into the system upon initiation of the pathway.- Physicians and nurses appreciate that cognitive-communication and swallowing abilities are important to the health and well-being of their patients.- SLP services are particularly valued when those services contribute to reducing the length of stay (LOS), facilitate discharge planning, and reduce the occurrence of medical complications such as pneumonia.IV. Collaboration with Other Disciplines - Speech-language pathologists collaborate with many professionals within the hospital system, including physicians, nurses, other rehabilitation providers, dietitians, social workers, and case managers. - The role of the SLP may be more consultative in nature in this setting than in any other, and the focus is more on patient management than direct treatment. - Collaboration with nursing staff is essential.o Ensure SLP recommendations are followed. o Scheduling visits for assessment and therapy when the patient is least fatigued and maximally alert often requires working cooperative with the nurse staff and other rehab therapy professionals.- Collaboration with nutrient services is essential. o Ensure food is prepared and presented in the manner that may be managed best by the patient.- Collaboration with case managers and staff providing social work services is essential.o Ensure that the patient has access to continues speech-language rehabilitation after discharge.- Diagnostic evaluations of persons with dysphagia often require coordination/collaboration with physicians, nursing staff, radiology, and dieticians. V. Medical Documentation: Requirements - Documentation is maintained in the patient's chart, if in hard copy, which remains on the floor where the patient is located (or travels with the patient for special procedures).- Many facilities are becoming more automated and there is a trend towards "paperless" charts or electronic medical records. - Documentation requirements vary by facility, but the SLP in an acute care hospital setting must be able to write concise reports or SOAP notes (Subjective, Objective, Assessment, Plan) that address only essential patient information for appropriate patientmanagement.VI. Guidelines for Entries in Progress Notes - Styles and procedure for medical charting vary among institutions.- Medical charts/notes should always be signed by the actual provider- Include name and title or degreeo Sarah Smith, speech-language pathologist (“speech path”), CCC-SLPo Sarah Smith, M.S., CCC-SLP - When making chart entries you should:o Use pen, preferably black ink.o Enter the date and time of the note and duration of visit.  Some facilities prefer military time (e.g. 18:00).o Record only information related or significant to your assessment or treatment plan.o Correct all mistakes but do not erase or “white out” the error. Draw a line through your make or insert missing information with a caret (^). Put your initials next