Chapter 1: Speech-Language Pathology in Medical Settings Flashcards
Discuss the three C’s: Concurrence, Cooperation and Coordination in the hospital
- SLP services of any kind are prescribed by a doctor, medical assistant, or nurse practitioner.
- Doctors bear the authority but also the largest portion of risk.
- SLP’s must work closely with nurses to make sure therapy is accomplished.
- SLP’s must coordinate with a large number of different types of medical professionals to make sure everyone’s piece of the medical pie is served.
- SLP’s must coordinate with peers in other settings for transfers.
Discuss the Scope of practice regarding Mental Status Assessment
SLP’s administer informal and formal assessments of attention, memory, orientation, and communication.
Discuss the Scope of Practice Re Swallowing and Feeding Evaluation and Treatment
SLPs are asked to evaluate swallowing, identify dysphagia and r/o aspiration risk. Generally, this follows the following procedure.
- Review medical record
- Interview staff and family and patient
- Clinical (bedside, non-instrumental) assessment
a. eval oral motor and sensory functions
b. breathing, phonation and coughing checked - Follow-up instrumental test, if warranted
a. VFSS b. FEES
Management of dysphagia can involve dietary consistency prescriptions, and special neo-nate care….enteral feeding, special nipples, coordination with lactation nurse specialist.
Selection and administration of treatment with education.
Discuss the scope of practice with neurogenic language disorders
Diagnostic assessment, either brief or complete.
Differentiation of pathological communication disorder from medication or delirium affects.
Selecting and implementing treatment.
Education.
Discuss the scope of practice regarding neurogenic speech disorders.
Assessment, differential diagnosis, treatment.
Oral motor, speech intelligibility, phonation, resonance, velopharyngeal sufficiency, respiration, perceptual and acoustic analysis. Some treatments, like LSVT, require training. AAC methods and technologies must at times be selected and programed.
Discuss the scope of practice with the assessment and treatment of cognitive status.
In many facilities, the SLP is assigned to perform cognitive status exams on all patients with certain diagnoses, e.g. TBI. They may be required to cognitively assess anyone that reaches a particular level on the Rancho Levels of Cognitive Functioning.
Treatments include improving orientation, attention, vigilance, and other cognitive functions, as well as providing family education.
Discuss the scope of practice with regard to voice and resonance disorders.
The SLP works closely with the Otolaryngologist in instrumental assessment. The physician provides medical diagnosis, while the SLP provides functional diagnosis, differentiation, and treatment. Computerized speech lab acoustical analysis and nasometry, nasendoscopy, and laryngostroboscopy may be employed as functional diagnostic procedures.
Discuss the scope of practice regarding pre- and post-head and neck surgery speech assessment.
The SLP should be involved to provide pre-surgical counseling and post-surgical speech rehab. Alaryngeal communication methods may be taught such as electrolarynx, esophageal speech, tracheoesophageal puncture (TEP) voice prosthesis. Referral to support groups, testing esophageal adequacy for TEP (air insufflation test), fitment, and helping the patient with lifestyle changes.
Discuss the scope of practice with regard to tracheostomy patients.
Close work with respiratory therapist, primary nurse, physician and ENT. Evaluation of cognitive status and selecting appropriate communication systems based on level of cognitive functioning, including Passy-Muir valve, writing notes, alphabet board, electrolarynx, etc.
Discuss the scope of practice regarding pharmacologic, surgical, or rehabilitative therapy outcomes.
In some facilities, the SLP may be asked to perform baseline and follow-up evaluations of speech, language and swallowing. This happens most frequently during clinical trials and in teaching hospitals.
Discuss the SLP’s participation on interdisciplinary and multidisciplinary teams.
These can include
rehab medicine and intermediate care teams, geriatric unit teams, extended care rehab teams, feeding/swallowing/dysphagia teams, and special treatment protocol consultation teams including velopharyngeal insufficiency (VPI) team, tumor board, or otolaryngology/head and neck surgery indications team.
Discuss the SLP’s role in staff education
The SLP participates in rounds, teaching conferences or in-services in their fields of care.
Discuss the SLP’s role in data collection and research
While medical SLP clinicians typically are involved in formal research, they typically participate in ASHA’s National Outcomes Measurement System (NOMS), as well as supply data for the management of care, and for quality assurance (QA) monitors.
All data collection and usage must follow facility protocols designed to implement HIPAA.
Discuss the requirements for continuing education.
To maintain certification, the SLP must be involved in ongoing continuing education. These are reviewed triennially by ASHA.
Discuss the SLP’s role in ensuring reimbursements
The SLP must provide appropriate documentation to third party payers, such as the Centers on Medicare and Medicaid Services (CMS)
