Evaluating the Feasibility and Validity of Using Trained Allied Health Assistants to Assist in Mealtime Monitoring of Dysphagic Patients

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

“…The importance of targeted training prior to dysphagia task delegation, is supported by a study by Sharma and colleagues (2012) in which AHAs reported increased dysphagia knowledge and confidence following training to support dysphagia assessments occurring via telehealth. High level of agreement between AHA and SLP raters following task specific training for dysphagia related tasks was also identified in a study investigating the validity of using AHAs to complete mealtime observations in which agreement reached 94% (Schwarz et al, 2018).…”

“…Systematic study of AHA utilisation within adult SLP practice, has been primarily discussed in relation to aphasia rehabilitation, which identified an increase in treatment intensity, however, also contributed to increased planning and training time for the SLP during initial implementation (Gunning et al, 2017;Wenke et al, 2014). In the clinical area of dysphagia, studies investigating the AHA role to facilitate dysphagia assessment has been limited to the area of telepractice (Sharma et al, 2012;Ward et al, 2012aWard et al, , 2012b and more recently mealtime observations (Schwarz, Ward, Cornwell, Coccetti, & Kalapac, 2018). Key barriers to implementing AHA delegation in SLP practice have been raised by several authors, including the need for pre-service training, changes in workplace processes and lack of validity and efficacy data related to assistant provided interventions (Goldberg et al, 2002a;Goldberg et al, 2002b).…”

“…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). However, the validity and feasibility of dysphagia screening completed by an AHA has not, to our knowledge been explored in the literature.…”

“…Similarly, a study investigating the delegation of mealtime observation to trained AHA staff to identify presence of dysphagia has revealed positive perceptions and accurate risk ratings by the AHA when compared to the SLP observations (Schwarz et al, 2018). Systematic research has confirmed that dysphagia screening in particular, has promising validity and feasibility when delegated to trained AHAs (Schwarz et al, n.d).…”

Carbonation as a sensory enhancement strategy: evidence for clinical implementation

“…Neurogenic dysphagia requires timely and evidenced based intervention (Bath, Lee, & Everton, 2018), given the significant impacts on patient outcomes and health care costs outlined previously. Demand management strategies, such a dysphagia screening completed by other professional groups such as nursing (Martino, 2014) or allied health assistants (Schwarz, Ward, Cornwell, Coccetti, & Kalapac, 2019) help support the Speech Pathologist (SP) to manage increasing caseloads and ensure early identification and referral of patients with neurogenic dysphagia.…”