The Speech-Language Pathology First Contact Assessment for Voice Disorders.
Channel: Christopher Payten
Date: 2020-05-15

Christopher Payten, PhD Candidate, Gold Coast University Hospital and The University of Sydney.
Associate Professor Cate Madill, PhD, Director Dr Liang Voice Program, The University of Sydney.
Dr Kelly Weir, PhD, Conjoint Principal Research Fellow - Allied Health, Griffith University.

Abstract
Objectives: A new extended scope Speech-Language Pathology (SLP) assessment clinic aimed to reduce Ear, Nose and Throat (ENT) service demand for patients referred with symptoms of dysphonia through SLP-led first contact assessment.  The aim was to reduce waiting times for patients referred to a tertiary referral public hospital ENT outpatient service and provide access to the right care for patients suitable for SLP treatment, within clinically recommended time-frames.   
Methods/Design: The SLP-led clinic commenced in May 2016.  The SLP provided a comprehensive multidimensional “one-stop” assessment in a clinic running parallel to a specialist ENT clinic.  Assessments included case history, audio-perceptual voice evaluation, video stroboscopy, and psychometric measures.  Video stroboscopy images were reviewed jointly by the ENT and SLP for diagnostic interpretation, and treatment planning.  After SLP assessment, patients were either managed by SLP without ENT, or reinstated onto ENT wait list.  We measured: waiting times  24 months pre and 12 months post implementation; number of patients requiring ENT intervention after assessment in the SLP-led clinic; adverse events; and service delivery costs.
Results: A total of 153 patients were seen in the SLP-led first contact clinic between May 2016 – July 2017.  Waiting times to initial assessment for patients with low priority symptoms of dysphonia reduced from an average of 151 days to 50 days.  Most patients were managed by SLP and discharged without the need for ENT intervention (81.05%), 29 patients were returned to ENT for management, 11 of which where recategorised for urgent ENT assessment.  No adverse events were recorded.    
Conclusion: The SLP-led first contact assessment improved waiting times for assessment of patients with symptoms of dysphonia, and improved access to treatment.  Future research on cost effectiveness, sensitivity of the SLP assessment process and predicted capability of the SLP assessments to identify surgical need will provide more confidence in the model.