Telehealth as a model of service delivery in adult speech and language therapy services during the COVID-19 pandemic
At the start of the COVID-19 pandemic in March 2020 approximately 1.5 million vulnerable people in the UK were advised to self-isolate for 12 weeks. This cohort included a significant number of individuals whose requirement for Speech and Language Therapy input is paramount.
As hospital trusts reached ‘phase two’ of their COVID-19 action plans in March, outpatient and community speech and language therapy services were cancelled. Unnecessary modification of diet and fluids by untrained staff has occurred with implications for quality of life, increased risk of complications from aspiration and increased costs for clinical commissioning groups (CCGs) through unnecessary prescriptions of thickener. The feeling of social isolation due to communication impairments is exacerbated by non-face-to-face contact with family, friends and social groups.
With the number of deaths from a decrease in normal service provision remaining unknown, an urgent priority for adapting the model of care was required. High-quality assessment and treatment via video streamed interactions provides an option for distant healthcare provision.
At Hampshire Hospitals Foundation Trust (HHFT), a video assessment and therapy service has been established using Microsoft Teams. Patients with dysphagia, communication and voice impairments have been deemed suitable for telehealth.
With our use of telehealth, at-risk patients have been seen and continuity in therapy achieved. Initial assessments have been provided sooner than previous service models allowed, and significantly sooner than available outpatient or home visit appointments in the current climate. Reduction in dysphagia risk and admission avoidance support has been achieved. Dysphagia rehabilitation sessions have continued to support patients towards their goal of returning to oral intake and timely commencement of voice therapy following urgent requests from ENT (Ear, Nose and Throat) surgeons has enabled prompt intervention.
From the patient’s perspective, there has been increased ease of access to the service and increased availability of speech and language therapy input. In addition, there has been an absence of travel time and reduced stress and cost of parking. All at a time when routine face to face appointments have been cancelled or postponed.
Clinician feedback has confirmed shorter response times to new referrals and improved continuity of care. Challenges have included: technological difficulties, patient and carer motivation and the availability of thickener for initial dysphagia assessments for patients in their own homes. A solution for access to thickener may be achieved through direct delivery to patients from wholesalers or general practitioner with a subsequent telehealth appointment offered for re-assessment. Technological difficulties have been overcome using Attend Anywhere alongside Microsoft Teams.
Achievement of successful clinical outcomes without the need for a face-to-face assessment provides an indication that telehealth is an appropriate method of service delivery, however, certain patient groups and those unable to access the required technology will continue to require an in-person assessment. These will be offered in line with clinical necessity and government restrictions. Those who require instrumental assessments of swallow and voice will also be required to attend outpatient clinics. With possible delays to these clinics, consideration of strategies and rehab exercises at an earlier stage of treatment, and prior to instrumental assessment, may be indicated and have longer-term impacts for speech and language therapy practice.
Benefits to telehealth, which will remain applicable beyond COVID-19 include shorter total consultation times through simultaneous appointment delivery and note writing, reduced mileage costs, reduction in clinician travel time and reduced wait times.
Whilst clinically required given the current pandemic, thought should be given to service provision in a post-pandemic world. Telehealth has the potential to enable faster response times and shorter consultations while achieving successful clinical outcomes and patient satisfaction. It is envisaged that long-term, widespread use of telehealth will support efficient time management, a reduction in travel costs and achievement of the NHS long term plan. We believe that with telehealth becoming more engrained in healthcare, clinician and carer motivation will increase and the paradigm of face-to-face consultations being the most effective will be challenged.