elderly lady smiling

Swallowing assessment and management using digital technology

Consulting elderly patients online to provide timely Speech and Language Therapist (SaLT) assessments and reducing waiting times and the need for costly travel.

The challenge

Swallowing difficulties (dysphagia) are common after neurological insult or disease (e.g. stroke, acquired brain injury, head and neck cancer, brain cancer, respiratory conditions or dementia). Dysphagia is associated with increased morbidity, mortality and reduced quality of life. Pneumonia is a common disease resulting from dysphagia and is associated with higher costs of care.

Speech and Language Therapists (SaLT) have a unique role in the assessment, diagnosis and management of dysphagia. Prompt assessment can avoid deterioration in health and subsequent admission to hospital.

The purpose of this project was to undertake a pilot using a technological solution to conduct appropriate SaLT assessments remotely which will enable a greater number of assessments to be completed by each assessor.

The evidence

The concept of teleswallowing has been piloted before and has been fully implemented in Blackpool.

This project aimed to:

  • Use teleswallowing to link to and provide input to nursing homes remotely.
  • Provide SaLT communication therapy using computer technology using tablets, laptops and ‘video as a service’ technology.

SaLT assessments/interventions for swallowing were provided remotely into the selected nursing homes. Nurses in the selected nursing homes were trained to assist the SaLTs to deliver swallowing assessments to patients within their homes and the therapists were trained on the use of the technology to use in the hospital.

The customer found there has been a misbalance between clinical needs (long waiting lists for face-to-face swallowing assessments) and clinical skills (limited number of speech and language therapists) in recent years.  This led the commissioners to consider alternative ways of delivering the service, using digital technologies while maintaining high-quality clinical management and value for money.

The customer sought to pilot Teleswallowing in a selected number of Care Homes- assessing patients with swallowing difficulties remotely using a video platform applying locally available IT solutions (for the pilot purposes, the Care homes with the high number of referrals to SaLT).

What we delivered

The customer approached SCW with a work request –seeking technical consultancy and support for the pilot. After careful consideration, a comprehensive business analysis resulting in a Statement of Works by Lucksri Hewawasam, Senior Programme Manager for SCW, and receipt of the customer approval, the following was agreed and delivered to customer/care home satisfaction.

  • Procurement and supply of tablet devices (Samsung Galaxy Tab A / Android 7.1) – pre-configured with Skype for Business. All generic apps were removed, tablets were encrypted (to meet information governance requirements) prior to being delivered to three care homes (pilot phase). Samsung Galaxy tablets were selected because each tablet was half the price of a similar iPad (like-for-like) and suited perfectly for the customer requirements.
  • Skype for business licences were procured for both care homes (tablet devices) and the care home assessment centre staff (who provide Teleswallowing assessments). Each Skype for Business audio/video licence cost approx. £23 for a whole year.

Staff training was delivered by a third party (Teleswallowing Ltd) prior to the pilot go-live.

Lucksri visited each of the three care homes to configure tablets to the local Wi-Fi network, test out Skype for business configuration and testing before the pilot began. Also to ensure staff were trained and confident in handling tablet devices. He also installed Skype for Business on care home assessment centre staff laptops and trained them on how to use Skype for Business audio/video conferencing for remote assessments.

The outcome

The pilot phase began when the care home referred some of their residents to their assessment centre. This referral resulted in the following key benefits from the outset.

  • The saLT assessor could offer a Teleswallowing assessment on the same day (as compared to 10-12 days wait for a physical visit)
  • The saLT assessor could successfully connect to the care home using skype for Business in her laptop and tablet provided to the care home
  • Three successful swallowing assessments (without having to visit the care home in person) were done in under an hour.
  • Saved one hour of driving (approximately 30 minutes each way on a good day). Travelling distance is approximately 42.2 miles round trip which translates to a saving of £19 per visit.
  • All the patient contact, liaison with care home staff and resulting paperwork were done within 1.25 hours.

The process caused minimal distress to elderly residents who were assessed using this approach. Video and audio quality during the interaction was clear and care home staff/patient could follow instructions given by the SaLT assessor.

Thanks, Lucksri for making that possible today! 3 successful swallow assessments done in under an hour. 1 upgrade from stage 1 fluids to thin fluids, and fork-mashable to normal diet in 14 mins 1 check that puree diet is right for a patient in 7 mins 1 upgrade from puree to pre-mashed diet in 11 mins. Saved 1 hour of driving (30 mins each way) and did all contact, liaison with nurses and paperwork within 1.25 hours. - Christine Bibby, Specialist Speech & Language Therapist

Overall - the experience was a success to patient, care home staff and the SaLT assessor.  

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