Top of Scope: Evaluation of a First-Contact Speech Pathology Model of Care within a Tertiary ENT Clinic

Ms Danielle Stone1, Ms Mary-Ellen  Tarrant1, Ms  Julia Capper2, Ms Anna Giuffrida2, Ms  Jessica Drysdale2, Dr  Martin Forer3

1Department of Speech Pathology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia, 2Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia, 3Department of Ear Nose & Throat Surgery, Royal North Shore Hospital, St Leonards, Australia

Background: The Royal North Shore Hospital Ear Nose & Throat (ENT) Outpatient clinic is a high-demand service with approximately 2,700 appointments delivered annually. Over 70% of patients referred wait over 12 months, risking clinical deterioration, poor quality of life and hospital admission; all associated with potentially unavoidable but significant financial costs. A 3-month audit of referrals found approximately 11% were for conditions that could benefit from primary management by a speech pathologist.

Method: A first-contact speech pathology model of care within the ENT clinic was designed and piloted. Primary and secondary referral pathways, consultation and redirection criteria, adverse events and discharge outcomes were reviewed.

Results: In the first 6-months, 21 patients were seen via the primary pathway and 18 were seen via the secondary pathway; approximately 15% of all referrals over this period. In the primary contact model, the most common reason for referral was laryngeal sensory symptoms (n=7), followed by dysphonia (n=4). Fifteen of the 21 patients required consultation with ENT; the most common reason being identification of an additional ear or nose problem (n=4). Seven of these patients were returned to the primary ENT clinic, 4 of which were identified with a head and neck cancer risk. Five patients required further joint speech pathology/ENT assessment. Eight patients were discharged after initial and subsequent consultation with the speech pathologist and two were referred to local speech pathology services and subsequently discharged. There were no adverse outcomes.

Conclusion: Preliminary evaluation of a top-of-scope speech pathology model of care highlighted the significant potential for such service deliveries. Two-thirds of patients in this model were managed primarily by the ENT speech pathologist. Utilising highly-specialised allied health practitioners in first-contact models may assist in reducing waiting times, minimising repeat clinic visits and directing patients to timely, effective and appropriate interventions, without adverse outcomes.


Danielle Stone is a Clinical Specialist Speech Pathologist at Royal North Shore Hospital, Sydney, with 18 years clinical experience working in tertiary settings across Sydney and Canada. Danielle is in her second year of PhD studies investigating dysphagia and dysphonia in non-traumatic cervical spine injury and chronic pain. Danielle was awarded a 3 1/2 year full-time scholarship to complete her studies and since commencing, has been awarded a range of prizes for research presentations. She is both a regular university guest lecturer in Sydney and a peer reviewer for several international journals.

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