[Dysphagia] weekend coverage in acute care

[malindam at samhealth.org (malindam@samhealth.org)]

I'm the SLP at a small acute care facility in Oregon.  There are two other acute care facilities within a 20 mile radius of my facility.  The 4 therapists at the three facilities have worked collaboratively for years, sharing CE info, standardizing forms, arranging inservices, etc.  We also share call on weekends, which means only 1 weekend a month for each therapist. Initially we only did new swallow evals but now, with LOS so short we also followup on any speech/language and/or swallow pt that the in house therapist requests.  This is particularly helpful when a pt is admitted on Friday and eval'd Friday afternoon.  As long as we are notified by 15:30 we will see the pt that day.  Now the three hospitals are in the same system so the logistics are even easier.  We do get paid a weekend differential and get a day off before or after the weekend we worked.  We're also paid mileage between hospitals.  Physicians, nsg and pt's really seem to appreciate our availability.

The most recent development is that two of the therapists requested a four day week, one ending on Saturday and the other beginning on Sunday.  So, for the time being, they are taking the weekend call.  

I don't think one can prescribe a system that will work for every facility.  This works for us because it is a system we devised and coordinate among ourselves and we share a pretty close professional relationship.  Creativity and flexiblity can go a long way in figuring out what might work in your area.

Malinda Moore, CCC-SLP  

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Morgan Jennie (RXP) Speech & Language Therapy
Sent: Tuesday, January 25, 2005 7:07 AM
To: Patti Larghi; dysphagia@b9.com
Subject: RE: [Dysphagia] weekend coverage in acute care


It sounds like your patients get reasonable treatment only waiting up to 24 hours. Working in the NHS in Britian most hospitals do not have SLT cover for weekends. If a patient is referred late on a Friday afternoon then they have to wait until Monday morning before they are seen, which means that they are NBM for the whole time. 
Obviously this is far from ideal but we are not willing to lose our Monday-Friday working practice. If a doctor is concerned about nutrition and hydration then they often pass an NG tube until the patient can be assessed by our department.
 
Jennie Morgan
Speech and Language Therapist
Durham

________________________________

From: dysphagia-bounces@b9.com on behalf of Patti Larghi
Sent: Tue 25/01/2005 14:53
To: dysphagia@b9.com
Subject: [Dysphagia] weekend coverage in acute care



I am hoping to get some feed back from those of you that work in an acute
care setting. More specifically smaller hospitals that don't have regular
weekend coverage.  Firstly, we are trying to establish a protocal for
nursing to use as a screening tool to establish a need for an order for a
swallow eval.
The second part of the problem is covering the swallow evals once they are
written. Currently we use an on-call program. The SLP has 24 hours to
respond. The problem is of course those patients that enter the hospital on
Friday p.m. and the physician writes on order for patient to be NPO until
evaluated by SLP. If our on-call therapist can not make it until Sat. p.m.
we feel this is an excessive length of time for the patient to wait  but at
this point we are in a dilema at to how to solve this issue.
Our nursing director suggested that the patinet receive a dysphagia diet
(Pureed honey thick liquids) until the eval and that the nurse be provided
with a screening tool to assure diet tolerance.
Anyway I would appreciate some feed back from those of you working in
simliar settings as to what your hospitals are currently doing to keep
patient safe and to provide nutrition in a timely manner.

Thanks, Patti Larghi


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