Delegation models in dysphagia management: Current policy, clinical perceptions and practice patterns

Expanding speech pathology delegation practices: engaging Allied Health Assistants (AHAs) in dysphagia management in the acute hospital setting

“…Office of Queensland, 2016). Within the context of the Australian health service, AHA delegation is gaining momentum in the field of dysphagia management, with both policy and SLP staff identifying that dysphagia tasks are within the AHA's scope of practice (Schwarz, Ward, Cornwell & Coccetti, 2019 respondents reported that 24% of their time was utilised on tasks which could be safely delegated to a trained assistant including providing treatment and conducting administrative tasks (Somerville et al, 2018). Similarly, utilisation of AHAs in the area of dysphagia management has only recently gained attention in areas such as supporting telepractice including supporting the telehealth clinician to conduct an oromotor examination, position the patient appropriately and provide assistance with feeding during a clinical swallow assessment performed remotely (Sharma et al, 2012) and mealtime monitoring (Schwarz et al, 2018).…”

“…Thus, although the benefits of nurse led dysphagia screening are well documented, alternative models of service delivery (including alternative models of dysphagia screening) require investigation (Brooks et al, 2008;McGrath et al, 1989;Young et al, 2015). Brooks et al, 2008;Duckett, 2005aDuckett, , 2005bMunn et al, 2013;Nancarrow et al, 2013;Schwarz et al, 2019;Somerville et al, 2015;Young et al, 2015). These models include AHA delegation, in order to find solutions to meet the growing service demands (Allied Health Professions Office of Queensland, 2016;Young et al, 2015).…”

“…These models include AHA delegation, in order to find solutions to meet the growing service demands (Allied Health Professions Office of Queensland, 2016;Young et al, 2015). However, delegation models in the Allied Health professions have received less research investigation and site-specific adoption (Brooks et al, 2008;Duckett, 2005aDuckett, , 2005bMunn et al, 2013;Nancarrow et al, 2013;Schwarz et al, 2019;Somerville et al, 2015;Young et al, 2015) than similar nursing models.…”

“…Specific to the clinical area of dysphagia services, delegating dysphagia related tasks to trained AHAs has been found to have positive clinician acceptance (Schwarz et al, 2019).…”

“…Current evidence suggests that AHAs are under-utilised in the clinical setting, with a greater number of non-clinical tasks being performed (Stute et al, 2014). Although there are multiple positive drivers for introducing AHA screening models (Schwarz et al, 2019;Sharma et al, 2012) multiple other factors may influence the introduction of AHA delegation models (Stute et al, 2014) for services such as dysphagia screening. However, to date there is limited understanding of the specific factors that may influence the implementation of these services or pose contextually specific barriers.…”