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Screening adult patients with a tracheostomy tube for dysphagia: a mixed-methods study of practice in the UK.
- Source :
- International Journal of Language & Communication Disorders; May2016, Vol. 51 Issue 3, p285-295, 11p
- Publication Year :
- 2016
-
Abstract
- Background Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia), and because of their medical acuity, complications in this patient population can be severe. It is well recognized that swallow screening in stroke significantly reduces potential complications by allowing early identification and appropriate management of patients at risk (by health professionals), thereby reducing delays in commencing oral intake and preventing unnecessary, costly interventions by speech and language therapists (SLTs). However, there is no standardized swallow screen for the tracheostomised population and there is a paucity of literature regarding either current or best practice in this area. Aims To investigate current UK practice for dysphagia screening in adult patients with tracheostomy tubes and to explore and describe health professionals' perceptions of their current practice or current systems used. Methods & Procedures A mixed-methods approach was adopted comprising a semi-structured online questionnaire and recorded follow-up telephone interviews. Participants were SLTs, nurses and physiotherapists working with patients with tracheostomies. Responses were analysed to determine current practice with regard to swallow screening. Thematic analysis of interviews allowed further exploration and clarification of the questionnaire findings. Outcomes & Results A total of 221 questionnaires were completed. Approximately half (45%) the participants worked in trusts with formal swallow screens, whilst the remainder used a variety of other approaches to identify patients at risk, often relying on informal links with multidisciplinary teams (MDT). In line with current evidence, patients with neurological diagnoses and a tracheostomy were consistently referred directly to speech and language therapy (SLT). Only one-quarter of questionnaire participants thought their current system was effective at identifying patients at risk of swallowing problems. Eleven questionnaire participants were interviewed. They highlighted the important role of MDT team working here, emphasizing both its strengths and weaknesses when working with these patients. Conclusions & Implications Current practice in the UK for screening patients with a tracheostomy for swallow problems is varied and often suboptimal. Despite the evidence for enhancing outcomes, MDT working is still perceived as problematic. A swallow screening tool for use with this population, to enhance MDT working whilst also ensuring that practice fits in line with current evidence, may improve patient safety and care. [ABSTRACT FROM AUTHOR]
- Subjects :
- TRACHEOTOMY patients
DEGLUTITION disorders
ATTITUDES of medical personnel
SPEECH therapy
MIXED methods research
ADULTS
EDUCATIONAL attainment
MEDICAL personnel
ATTITUDE (Psychology)
CONTENT analysis
HEALTH care teams
INTERVIEWING
RESEARCH methodology
MEDICAL referrals
NURSES' attitudes
QUESTIONNAIRES
TELEPHONES
WORLD Wide Web
QUALITATIVE research
TRACHEOTOMY equipment
QUANTITATIVE research
THEMATIC analysis
DATA analysis software
WORK experience (Employment)
PHYSICAL therapists' attitudes
SPEECH therapists
DESCRIPTIVE statistics
DIAGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 13682822
- Volume :
- 51
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- International Journal of Language & Communication Disorders
- Publication Type :
- Academic Journal
- Accession number :
- 114639727
- Full Text :
- https://doi.org/10.1111/1460-6984.12205