SLTs Chrissy Bibby and Lauren Cooper share their experience of getting a head start in the world of telehealth.
When lockdown struck in March 2020, and dysphagia home visits were discouraged, we embraced the opportunity to expand our existing telehealth service.
We provide community speech therapy to adults in the New Forest with acquired dysphagia and communication difficulties. In 2018, we undertook digital practitioner training, to provide remote swallowing assessments as a way of providing a more efficient service. The approach involved training care home staff to Level 4 of the Eating, Drinking and Swallowing Competency Framework (EDSCF), facilitating a remote swallowing assessment, by palpating the swallow, under our instruction, over video. We trained staff in 6 homes to be dysphagia-trained facilitators (DTF), and over the following two years, all those involved became more confident.
The transition to offering more remote swallow assessments during Lockdown was an obvious solution. The video technology existed. The SLTs had the skills. Access to Wi-Fi is widespread. We knew we could conduct an adequate oro-motor assessment, see laryngeal excursion and hear the swallow and any altered vocal quality. The only difference being that the patient and their carer had not been trained in dysphagia beforehand (“non-dysphagia-trained facilitator”, or NDTF). Swapping all home visits to video where possible was a quick and easy process, and we believe our previous experience and confidence helped us immensely. In January 2020, home visits took up 67% of our activity, with only 4% being over video with DTF. Just four months later, in May 2020, our stats show a very different story, with 78% of assessments being conducted via video with NDTF, 3% with DTF and no home visits that month.
In the majority of our remote assessments, the facilitators lack formal dysphagia training, but with direct instructions, they can position the camera so that the SLT has the best available view, and we can provide immediate dysphagia recommendations. We still offer risk-assessed home visits if clinically indicated.
We are surprised that eight months into these “COVID times”, some services are assessing, diagnosing and managing dysphagia exclusively over the phone, and missing out on the extra information that video can provide.
Video is not just for dysphagia: we have found the majority of our communication patients have taken to video well, as experienced by Roxanne Kent in her August 2020 Bulletin article. Rapport building is still possible and patients are able to engage with resources easily – those with significant cognitive or hearing difficulties needing help from a family member. Patients have been excited to use video for the first time with a therapist and some go on to surprise family with their newfound technology skills!
We are reducing our carbon footprint by seeing patients via video, saving up to 80 miles of travel per patient. The frustration of arriving at a patient’s house when they are out, or being unable to rouse a patient is no longer an issue.
We believe our service has changed for the better and as normality resumes we will still provide a remote-first approach. We aim to roll out EDSCF Level 4 dysphagia training to further homes in 2021 to increase carer involvement in swallowing assessments.
We feel there are fewer barriers to telehealth than expected. Once staff in homes and family members become familiar with the technology, they are eager to facilitate this approach and can also see the benefits. There will always be exceptions where a video assessment has not quite given you the information needed to make a clinical decision, and we are aware of this. But in the COVID era, we must consider the risk of face-to-face contact, whilst continuing to provide a safe and effective service.