Almost all people with amyotrophic lateral sclerosis (ALS) experience a motor speech disorder, such as dysarthria, as the disease progresses. At some point, 80 to 95% of people with ALS are unable to meet their daily communication needs using natural speech. Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate augmentative and alternative communication (AAC) intervention; therefore, appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision-making issue. AAC acceptance and use have increased considerably during the past decade. Many people use AAC until within a few weeks of their deaths.

Medical errors and poor patient care have been impacted by communication failures despite mandates for effective patient–provider communication (The Joint Commission, 2010). There are a high number of communication vulnerable individuals in medical situations due to new medical conditions, preexisting conditions, and language differences, to name a few. The purpose of this article is to highlight strategies to support consistent, effective patient–provider communication in a medical setting. However, to guarantee patient–provider communication is consistent, policies and procedures must be in place to ensure appropriate orders are activated in a timely manner, personnel are assigned to support patient–provider communication, individualized communication needs are recognized and met, and quality measures are in place to ensure that high standards continue over time.

The purpose of this article is to discuss policy and systems change for patient-provider communication (PPC) for dysarthric speakers in medical situations. Six groups of communication-vulnerable patients are described. The types of medical orders that can be employed to facilitate PPC systems change in medical settings are discussed. Finally, accountability checklists to document the patient experience and the medical facility PPC program are provided.