Tangling with Telehealth in a speech pathology outpatient clinic

Mrs Tina Wilkie1, Dr Anne Vertigan1,2,3

1John Hunter Hospital, Newcastle, Australia, 2School of Medicine and Public Health, University of Newcastle, Newcastle, Australia, 3 Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, Australia

Background and aim: The use of telehealth has been promoted within health services within recent years. Outpatient speech pathology services at John Hunter Hospital had been almost exclusively face to face until restrictions were instituted due to COVID-19 in March 2020. Most of the outpatients were considered high risk for potential COVID-19 transmission due to chronic cough or presence of a laryngeal stoma, and were therefore triaged for telehealth appointments. The project aim was to evaluate the clinical utility of telehealth as an alternative service delivery.

Method: Data was collected for 95 outpatients aged over 18 years who attended telehealth sessions (either telephone or video) over a nine week period. Diagnoses included cough / vocal cord dysfunction, dysphagia, voice, globus and laryngectomy. After each session the treating speech pathologist evaluated the session using a purpose-developed form.

Results: 100% of initial assessments had to be modified due to the telehealth format due to tactile, audio and visual limitations. This delayed clinical progress. 97% of therapy sessions were rated as having limitations due to telehealth format, with the most common issue being that sound and/or visual quality was insufficient to demonstrate therapy techniques or to make perceptual judgements about the accuracy of the patient’s attempts at therapy exercises. Technical issues were experienced with 47% of sessions. Video had more clinical utility than telephone sessions in most cases, but was plagued by more technical difficulties which took extra time and could not always be resolved. Technical difficulties did not reduce consistently over time.

Conclusion: Telehealth was a useful stop-gap measure during an unusual situation. Telehealth was most suited to education and case history gathering. It had limited utility for many technical aspects of assessment and therapy and therefore would not be suitable to replace face to face sessions for these patient populations.


Tina Wilkie is a speech pathologist with over 20 years of clinical experience working with acute adult inpatients with a range of neurological and head and neck diagnoses, and outpatients with chronic cough, vocal cord dysfunction, voice, laryngectomy and swallowing difficulties. She currently works at John Hunter Hospital in Newcastle, New South Wales. Her interest areas include wholistic patient-centred care, patient engagement in health change, and patients’ capacity to adjust and adapt to significant life-changing surgical interventions.

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