Avoiding critical consequences of dysphagia: A collaboration between speech pathology and nursing staff in mental health

Ms Alison Battin1, Ms Bronwen  Craig1, Ms Katrina  Moore1, Ms  Hardie Grace1, Ms Laura Foley1, Ms Clare Lorenzen2

1Westmead Hospital, Western Sydney Local Health District , Westmead, Australia, 2Cumberland Hospital, Western Sydney Local Health District, Westmead, Australia

Background: Critical incidents related to swallowing problems (dysphagia) such as choking, were identified in our local mental health facility. While many mental health facilities employ speech pathologists, our local facility does not. Current research into dysphagia in this population indicates an incidence of 35% compared to 16% of the general population. Limited staff knowledge of dysphagia in mental health facilities can lead to an increased risk of critical events. The project aimed to increase knowledge and awareness of dysphagia, to increase appropriate referrals to the outpatient speech pathology service.

Method: A multi-faceted approach was implemented. A flowchart of signs, symptoms and strategies for dysphagia was developed for nursing staff by speech pathology and mental health management. A referral pathway for speech pathology was developed, followed by education to staff within the facility. The model of handover for patients returning to the facility post speech pathology intervention was changed to incorporate patient-specific feeding plans. Project outcomes were measured using referral numbers.

Results: Seven in-services were provided to 81 staff, resulting in 31 outpatient referrals to speech pathology during 2017-2018. This was a significant increase from nil referrals the previous year. Referrals were all deemed clinically appropriate for dysphagia intervention. Since implementation, nil critical incidents have been reported to speech pathology.

Discussion: Project implementation has caused systemic change demonstrated by the increase in appropriate referrals, indicating an improvement in staff knowledge and overall patient physical care. This collaborative approach to patient care enabled mental health facility staff to identify dysphagia, implement strategies and work in partnership with speech pathologists to facilitate comprehensive assessment. Absence of further critical incidents highlights the benefits of this approach and need for ongoing collaboration. Proportionally, referrals remain low compared with reported incidence of dysphagia, indicating further work is required.


Alison Battin is the Head of Department Speech Pathology for Westmead and Auburn Hospitals in Sydney. She holds a Bachelor of Applied Science Speech Pathology (University of Sydney) and has a Diploma of Leadership and Management through NSW Health. Since graduating Alison has worked in the adult acute care setting and has specialised in the area of head and neck oncology. She is passionate about providing quality speech pathology services to the population of Western Sydney and has interests in workforce development and using innovative models of service delivery to overcome obstacles to patient care.

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