Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department

Abstract

Purpose

Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs.

Method

Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more “expanded” models (n = 4).

Result

SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as “expanded”). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services.

Conclusion

There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.

Keywords:

• dysphagia
• swallowing
• emergency department
• speech pathology
• models of care
• implementation

Acknowledgements

We wish to thank the speech-language pathologists who took their time to participate in the interview. We also thank Speech Pathology Australia and coordinators of Speech Pathology Email ChatS (SPECS) and dysphagia interest groups across Australia for assisting with dissemination of the expression of interest (EOI) for the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental material

Supplemental data for this article can be accessed at http://doi.org/10.1080/17549507.2022.2071465.