Specialist multimodal speech pathology service for head and neck oncology patients with an altered airway: implementation of a proactive and preventative community-based care via telepractice.

Abstract

Background: Patients with an altered airway require specialist Speech Pathology care, accessed largely via metropolitan tertiary hospitals. The current, highly medical model highlights economic inefficiency and inequitable access. Speech pathology care islargely provided in person via the multidisciplinary oncology clinic, with scheduling based on availability alongside ENT rather than clinical need. This contributes to overfilled clinics and inadequate capacity to focus on patient- centred activity and participation goals. In the absence of a supportive community-based service, patients are commonly readmitted to hospital or have prolonged admissions beyond the point of medical clearance to discharge due to the inability to provide structured high frequency post-acute care during transition home and into the community. Aims: This project focussed on improving equity of access to speech pathology for those living regionally and preventative interventions to improve client outcomes and avoid adverse events.Method: A 3-phase feasibility study was conducted to utilise telehealth (video and phone calls) to extend standard onsite care. In phase 1, pre-pilot data was collected and authentic co-design with consumers for a novel service model was completed, named Altered Airway Management Outreach Service (AAMOS). In phase 2, AAMOS was implemented with a small group of patients with analtered airway and evaluations of outcomes and sustainability planning occurred in phase 3. Results: There was an improvement in consumer experience withincreased availability and accessibility to speech pathology services, and eighty-five percent of patients achieved their rehabilitation goals during the pilot. A manageable clinical risk was identified in more than 50% of the telehealth sessions conducted under the pilot. Clinical risks were effectively managed in the session in approximately 70% of cases, with the remainder proactively escalated for priority care. Conclusion: The project has shown that AAMOS, a proactive intervention and service was instrumental in preventing serious complications and improving quality of life for patients.