Enhancing Speech Pathology scope with scoping

Ms Nicola Veness1, Ms Mary-Ellen  Tarrant1

1Royal North Shore & Ryde Hospitals, St Leonards, Australia

Fibre-optic Endoscopic Evaluation of Swallow (FEES) is an advanced scope of practice for speech pathology (SP). The Royal North Shore (RNSH) & Ryde Hospital SP department have adapted the QLD FEES competency to develop appropriate skills to provide speech pathology led FEES service across this department. This department covers two sites across three different service models: acute, rehab & community. This process has been refined since its introduction in 2015, enabling more clinicians to become competent over short periods of time. In conjunction with this, both sites have recently have recently secured funding and donations for Karl Storz C-MAC (RNSH n=2 , Ryde Hospital n=1) which is a more portal FEES equipment and dedicated for speech pathology usage

Results: Skill enhancement: In 2015, one clinician (of 15 FTE) was independently scoping on the wards; whereas is 2019, 8 clinicians (of 18 FTE) are independently scoping after achieving competency. A further 7 clinicians are working towards this competency at various stages.

Clinical Care: Overall the FEES service at Ryde Hospital demonstrated service enhancement and cost savings over the period of  The number of patients who received an instrumental assessment increased from 12 to 29 and the average wait time reduced from 6.6 to 1.2 days. The total annual cost for instrumental swallow assessments for patients based at Ryde Hospital reduced from $15, 595 to $6,347, and the average cost of an individual objective assessment reduced from $770 to $163.   This service enhancement was replicated at RNSH. The results of RNSH no longer using borrowed cumbersome equipment from the ENT specialists was an increase in the number of instrumental assessment being performed on the wards, optimising outcomes for patients with dysphagia.

Conclusion:  This new and dedicated speech pathology equipment has enabled our competency training process to be refined and increased efficiency in the development of this competency and dysphagia management for our patients while providing an enhanced service for our patients at a lower overall cost.


Nicola is the Senior Allied Health Project Officer in the Workforce Planning and Talent Development branch of the NSW Ministry of Health. Prior to this role, she was a senior speech pathologist and A/deputy manager at Royal North Shore and Ryde Hospitals in the Northern Sydney Local Health District. She has worked clinically as a speech pathologist in tertiary, metro and affiliate hospitals across Sydney, with a particular interest in acute, rehabilitation and palliative care for stroke and other neurological condition. Nicola holds a Bachelor of Commerce and a  Masters of Speech and Language Pathology. She is currently enrolled in a Masters of Public Health (UNSW).

Mary-Ellen is a Speech Pathologist with 20 years’ experience in the profession; 10 of those as the Head of Department of the Speech Pathology Department across Royal North Shore and Ryde Hospitals in Sydney’s lower North Shore. Prior to moving into management, Mary-Ellen had over 10 years’ experience working with adult caseloads in two major tertiary teaching hospitals in Sydney and similar settings in the UK. Her main clinical area of interest was in Neuroscience across the spectrum of neurology with a particularly focus in stroke and neurodegenerative disorders. Mary-Ellen holds a Diploma in Education, a Bachelor of Applied Science in Speech pathology & and MBA in Health Management.

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