Our PRIME Prehabilitation programme supports patients in the lead up to major oncology surgery. Currently our service is aimed at patients having oesophageal, pancreatic, bladder and gynae cancer surgery.
Our focus is to help patients prepare physically and emotionally for surgery, through supervised exercise classes and educational sessions, to support preparation and subsequent recovery.
The Acute Speech and Language Therapy Team assess, diagnose and support communication and swallowing difficulties arising from underlying medical conditions, post-surgery or the acute onset of illnesses.
The team work closely with carers and other professionals across a number of wards including Care of the Elderly, Respiratory and Intensive Care.
Dysphagia is the medical term for swallowing difficulties.
The extent of difficulties can vary:
Dysphagia can cause malnutrition, dehydration, choking and aspiration (food and/or fluids entering the lungs). Aspiration can lead to serious chest infections resulting in extended hospital admission and prolonged use of antibiotics.
It can also impact upon quality of life and well-being.
Dysphagia is assessed by specialist Speech and Language Therapists.
In the first instance, the Speech and Language Therapist will carry out a 'Bedside Assessment’:
The Speech and Language Therapist can then advise as to the safest options for food and fluids for that person, which may include modified consistencies.
It is important to liaise and work collaboratively with the multi-disciplinary team to ensure dysphagia is managed appropriately:
These recommendations will be reviewed, as appropriate, and amended in line with a person’s medical/dysphagia presentation.
The Speech and Language Therapist can also advise on the use of different swallow techniques or provide and supervise swallowing exercises to improve and rehabilitate the swallow function.
For more complex or unclear dysphagia presentations, the Speech and Language Therapy Team can complete an instrumental assessment, such as Videofluoroscopy, for a more in-depth, objective swallow assessment:
The Speech and Language Therapy Team recommend food textures and fluid consistencies according to internationally recognised descriptors (International Dysphagia Diet Standardisation Initiative – IDDSI):
More details of the various consistencies can be found at the following website: https://iddsi.org/framework/.
As swallow impairments can result in adverse health consequences, the Speech and Language Therapist will ensure the recommendations are communicated with the multidisciplinary team as well as explaining the advice to the patient and their families/carers.
The Acute Speech and Language Therapy team also use signs above the individual’s bed detailing the advice given.
For the Acute Speech and Language Therapy Team, the primary focus for communication is to support.
Patients requiring rehabilitation of their communication difficulties will be referred on to their local community rehabilitation team.
In particular, the acute team work to support individuals to make their own decisions regarding the care they receive and can provide training for staff/family/carers on how to communicate with a person with additional speech, language and communication needs.
The team receives referrals for swallow and communication assessment from the medical and nursing staff caring for patients on the ward.
If there is a concern that a patient may be having difficulty with their eating and drinking, we have trained nurses who can carry out a Basic Swallow Screen Test (BSST) which screens for dysphagia and facilitates timely and appropriate referrals into the acute service:
The Acute Speech and Language Therapy team provide a rapid response service for initial swallow assessments, aiming to see patients within 4-6 hours of referral.
The Acute Speech and Language Therapy team provide as much information to the patient and their family/carers as possible during their hospital admission.
Any long-term advice and/or recommendations will also be provided in a discharge report, a copy of which will be sent to the patient, or their next of kin as appropriate, their GP and any relevant community services that may be involved, for example Dietitians.
The Acute Speech and Language Therapy team will also organise onward referral, as required, to the patient’s local community Speech and Language Therapy team for continued input and support at home.