Our #ResNetSLT journal club on 27th March 7.30 – 8.30pm (UK time) will be led by Elicia Jones @EllieJSLT and Katherine Broomfield @KathBroomfield together with Hazel Roddam @HazelRoddam1 and other members of our team.
The open access paper is: Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review (2018) Stacie Attrill Sarah Louise White; Joanne Murray; Sue Hammond and Sebastian Doeltgen. https://doi.org/10.1186/s12913-018-3376-3
The theme of dysphagia this month has been chosen to link with Swallow Awareness Day on 13th March 2019 and to further highlight not only how dysphagia affects people’s lives but how speech and language therapy transforms the experiences of those living with the condition.
This paper recognises how healthcare systems worldwide are under an ever-increasing demand for services that must be delivered in an efficient, effective and affordable manner. More specifically this systematic review looks at how oropharyngeal dysphagia influences healthcare utilisation through length of stay (LOS) and cost.
Results highlighted the presence of dysphagia added 40.36% to health care costs across studies. Meta-analysis of all-cause admission data from 13 cohort studies revealed an increased LOS of 2.99 days. It was concluded that the presence of dysphagia across all causes was statistically significantly different, regardless of geographical location.
This systematic review demonstrated that the presence of oropharyngeal dysphagia significantly increases healthcare utilisation and cost, highlighting the need to recognise oropharyngeal dysphagia as an important contributor to pressure on healthcare systems. The review provides powerful messages for SLT services and highlights the unique and distinctive professional role SLTs have in early detection of oropharyngeal dysphagia.
Our Tweetchat will include discussions around dysphagia in our own work place and will also include reference to recent RCSLT dysphagia research priorities work. We look forward to you sharing your own personal experiences.
Here are the questions to structure our host chat:
- In your opinion what aspects of oropharyngeal dysphagia have the biggest impact on length of stay for this patient population?
- In your opinion what aspects of SLT management of oropharyngeal dysphagia could potentially reduce length of stay for this patient population?
- What other systematic reviews or other evidence syntheses are you aware of that have been used to inform clinical decision making or service development?
- How can we raise more awareness about the importance of dysphagia on health care costs and what did your service do to raise awareness about Swallow Awareness Day 2019?
HERE’S THE SUMMARY OF THE CHAT …
Our March Tweetchat coincided with swallow awareness month, so it seemed only appropriate to discuss a paper about dysphagia and to use the discussion to flag the campaign hashtag #swallowaware2019. The paper that inspired the discussion was: The impact of Oropharyngeal dysphagia on healthcare costs and length of stay in hospital: a systematic review. The paper was hosted by Katherine Broomfield (@kathbroomfield) and Ellie Jones (@ellieJSLT). You can view the paper and tweetchat questions here.
We were joined by 23 active tweeters who contributed 321 tweets to the hour-long discussion. The chat had international flare as we were joined by Tweeters from Italy, Hazel was tweeting from Germany and the paper’s author, Stacie Attrill, joined us from Adelaide, Australia. The discussion was lively with tweeters sharing their clinical experience, research knowledge and their reflections on current and future clinical practice developments and research ideas.
Question one asked about factors that impact on length of stay. Tweeters reported that the development of complications, such as pneumonia, the timing of referrals, and staffing resources were all factors that had an impact on the length of stay. There was discussion about the stage at which SLTs were getting involved in the management of dysphagia and how this can impact on the outcomes for patients. Stacie Attrill pointed out that their review identified that SLTs were not consistently involved in the manage of dysphagia and that clear protocols and guidelines were rare. This provides valuable food for thought based on the clinical experiences reported during the discussion. Would better guidance and the early involvement of relevant professionals improve outcomes and reduce length of stay?
This lead us nicely into question 2 – what clinical intervention for oropharyngeal dysphagia could reduce length of stay? We were signposted to a recent systematic review about stroke patients which indicates that early identification and SLT intervention does indeed reduce length of stay. Tweeters also indicated that the presence or absence of responsive community SLT services can also have an impact on length of stay. Examples of services that can provide ‘rapid response’ SLT interventions for people with dysphagia were shared but also reports that lack of community follow-up can delay discharge. In acute services, when and where SLTs are providing input was also variable. Some SLTs reported that they were piloting the provision of dysphagia assessments in urgent care or medical admission units. Stacie Atrill reminded us that the review identified that the impact of SLT input to dysphagia is not always clear. A prescient reminder of the importance of collecting data about the services we provide and the impact that these services have on economic parameters such as length of stay.
We asked tweeters to consider any other research that had an impact of the services that they delivered. It was fabulous to hear from some of our research-active tweeters about the early results of some of the projects that they are involved with (@gemmaclunie). Tweeters also presented information from local audits or service evaluations which are tentatively indicating that early SLT intervention in dysphagia management is critical to improved outcomes (@SChalmersSLT). We hope to learn more about some of these initiatives at the @RCSLT conference this autumn. Contributions from @Bristol_SLTRU reminded us of the importance of sharing audit results as well as considering how they can be developed into more substantial research projects, such as case studies becoming case series. We were reminded about the @NICEComms guidance for stroke and dementia. Both these documents support the early involvement of SLTs in the assessment and management of dysphagia and, alongside some of the research papers discussed, can support SLTs to develop some of the early intervention services that seem to be having positive impacts on people with dysphagia.
Finally, we discussed how we can raise awareness of the impact of dysphagia on healthcare costs and asked what people had done to mark #swallowaware2019. Many people had combined their awareness raising campaigns with the launch of IDDSI (?link to website). There was a call to consider whether we can develop national datasets for dysphagia with standardised outcome measures could help with this. Examples where such initiatives were having positive impact were given e.g. SSNAP data for stroke services. In preparation for next year’s Swallow Awareness campaign it was suggested that we share some of the economic impact data, such as that highlight in the paper that inspired this month’s tweetchat, to raise the profile of dysphagia and SLT involvement. The final word should probably go to Stacie Attrill:
Thanks to all those who were involved in the chat this month. We look forward to you joining us again next month on Wednesday 24th April at 7.30pm when we will be discussing a paper on Parkinson’s.