Outcomes of a multidisciplinary Ear, Nose and Throat Allied Health Primary Contact outpatient assessment service

Abstract

People wait longer than clinically recommended for specialist outpatient assessment in the public health system. 1 Governments are focused on redesigning service delivery, aiming to provide more flexible and patient-focused services, whilst increasing access to high-value care, at acceptably low costs. 2 Optimising and extending allied health practitioner (AHP) scope of practice can provide a responsive workforce whilst maintaining safe and quality health care. 3 Expanded roles for AHPs have gained popularity over the last decade, however, are not widely accepted as a sustainable alternative to the medical-led outpatient service model. 4

Telehealth voice assessment by speech language pathologists during a global pandemic using principles of a primary contact model: an observational cohort study protocol

“…These models provide a more efficient pathway for patients by reducing wait times for assessment and providing faster access to both ENT and voice treatment services, when compared with the ENTled models. [42][43][44] A recently published retrospective 5-year audit of a SLP led first contact clinic has confirmed the safety and service benefits of this model, including only a 2% re-referral rate over 5 years. 45 Whereas up to 80% of patients seen in these pathways can be managed by SLPs after diagnosis, around 7% are identified for more urgent ENT assessment, which may include further diagnostic tests (eg, radiology).…”

“…This is a prospective observational cohort study using principles from the SLPPC assessment protocol at Gold Coast University Hospital (GCUH), as previously described. 44 All participants triaged to the SLPPC clinic will be offered an initial telehealth assessment prior to being prioritised for a face-to-face laryngoscopy and ENT diagnosis to complete the diagnostic process.…”

“…Laryngoscopy may be provided by an advanced and credentialed SLP in a parallel clinic to the ENT, as previously described in the usual care SLPPC. 44 After case review of the SLPPC-T data and laryngoscopy imaging, the ENT will provide a diagnosis. The ENT will be blinded to the priority given by the SLP for urgency of laryngoscopy and SLP diagnostic impressions for SLPPC-T.…”

“…29 Allied health practitioner (AHP) expanded scope primary contact pathways are an emerging alternative to the traditional medical-led first contact pathways, providing high value and lower-cost care in areas where AHP treatment pathways exist. [38][39][40][41] One example is the speech-language pathology primary contact (SLPPC) model of voice assessment where patients are seen in a parallel clinic to ENT for face-to-face assessment by SLPs including case history, clinical voice assessment and direct laryngoscopy with stroboscopy, prior to case discussion with the ENT for diagnosis and treatment planning [42][43][44] (figure 1). These models provide a more efficient pathway for patients by reducing wait times for assessment and providing faster access to both ENT and voice treatment services, when compared with the ENTled models.…”

“… 45 Whereas up to 80% of patients seen in these pathways can be managed by SLPs after diagnosis, around 7% are identified for more urgent ENT assessment, which may include further diagnostic tests (eg, radiology). 44 The face-to-face SLP-led model relies on concurrent timetabling of SLP and ENT clinics, and a potential overuse of the ENT surgeons’ time and resources for 80% of patients. A remote SLPPC assessment may be considered a valuable step in the triage-assessment sequence for diagnosis of a voice disorder.…”