Adult Acute Inpatient Service

Dysphagia is the medical term for swallowing difficulties.

The extent of difficulties can vary:

• For instance, some people may find chewing to be laboursome and inefficient, whereas others may be unable to swallow certain foods and/or fluids safely.

Dysphagia can cause malnutrition, dehydration, choking and aspiration (food and/or fluids entering the lungs). Aspiration can lead to serious chest infections resulting in extended hospital admission and prolonged use of antibiotics.

It can also impact upon quality of life and well-being.

Dysphagia is assessed by specialist Speech and Language Therapists.

In the first instance, the Speech and Language Therapist will carry out a 'Bedside Assessment’:

• This involves assessing the cranial nerves involved in swallowing and evaluating a person’s swallow function and safety using various food and fluid consistencies.

The Speech and Language Therapist can then advise as to the safest options for food and fluids for that person, which may include modified consistencies.

It is important to liaise and work collaboratively with the multi-disciplinary team to ensure dysphagia is managed appropriately:

• For instance, in cases where there are no safe consistencies, alternative means of nutrition and hydration may need to be considered for that person.

These recommendations will be reviewed, as appropriate, and amended in line with a person’s medical/dysphagia presentation.  

The Speech and Language Therapist can also advise on the use of different swallow techniques or provide and supervise swallowing exercises to improve and rehabilitate the swallow function.

For more complex or unclear dysphagia presentations, the Speech and Language Therapy Team can complete an instrumental assessment, such as Videofluoroscopy, for a more in-depth, objective swallow assessment: 

• For further details on this assessment, please refer to the Videofluoroscopy clinic.

The Speech and Language Therapy Team recommend food textures and fluid consistencies according to internationally recognised descriptors (International Dysphagia Diet Standardisation Initiative – IDDSI):

• This framework ensures a standardised terminology which is transferable between hospitals and care settings, as well as between teams irrespective of location.

More details of the various consistencies can be found here.

As swallow impairments can result in adverse health consequences, the Speech and Language Therapist will ensure the recommendations are communicated with the multidisciplinary team as well as explaining the advice to the patient and their families/carers.

The Acute Speech and Language Therapy team also use signs above the individual’s bed detailing the advice given.

 

• There are many conditions which have associated communication impairments. For example:
  • Stroke
  • Brain Injury
  • Dementia
  • Progressive Neurological Conditions e.g. Parkinson’s Disease, Multiple Sclerosis, Motor Neurone Disease
  • Learning Disabilities
• Communication disorders can include difficulties with comprehension and expression of language in addition to the inability to articulate clearly.

For the Acute Speech and Language Therapy Team, the primary focus for communication is to support.

Patients requiring rehabilitation of their communication difficulties will be referred on to their local community rehabilitation team.

In particular, the acute team work to support individuals to make their own decisions regarding the care they receive and can provide training for staff/family/carers on how to communicate with a person with additional speech, language and communication needs.

The team receives referrals for swallow and communication assessment from the medical and nursing staff caring for patients on the ward.

If there is a concern that a patient may be having difficulty with their eating and drinking, we have trained nurses who can carry out a Basic Swallow Screen Test (BSST) which screens for dysphagia and facilitates timely and appropriate referrals into the acute service:

• This must be completed before a patient is referred to the team for difficulties swallowing.
• Referrals are then made by telephone to the department on extension 4680/4654. The patient’s name, hospital number, ward and details of admission must be provided, alongside BSST assessment results.

The Acute Speech and Language Therapy team provide a rapid response service for initial swallow assessments, aiming to see patients within 4-6 hours of referral.

The Acute Speech and Language Therapy team provide as much information to the patient and their family/carers as possible during their hospital admission.

Any long-term advice and/or recommendations will also be provided in a discharge report, a copy of which will be sent to the patient, or their next of kin as appropriate, their GP and any relevant community services that may be involved, for example Dietitians.

The Acute Speech and Language Therapy team will also organise onward referral, as required, to the patient’s local community Speech and Language Therapy team for continued input and support at home.

Telephone: 01483 571 122

Extension: 4680