The question many SLP’s are asking in the era of COVID-19 is, “Are we essential staff?” There is no easy answer to this question. My gut reaction is to say, “Of course we are essential!” but I am a bit biased so I’ll try to be as thoughtful and objective as possible. As healthcare workers, the state will provide us clearance if stopped on the road during a lockdown, but whether or not we should be entering the rooms of patients with COVID-19 is ultimately up to how our patients are being managed within our facilities. So then it becomes less a question of “Are we essential?” and more a question of “Is going into this room essential?”

What are the risks?

As SLP’s we are at an increased risk of receiving and spreading COVID-19 given the elicitation of coughing by providing PO trials and our close proximity to the patient’s airways (World Health Organization, 2020). Further, the PPE needed to protect ourselves and our patients is in desperate, short supply (Swift, 2020). Thus, it is important that we implement new policies and procedures that will keep ourselves, our coworkers, and our patients safe during a time when extreme caution is needed. The following is a detailed three step screening process that will determine if going into the patient’s room is indeed essential.

Do a chart review

If you are not already in the habit of doing a detailed chart review then start now. Take a look at the H&P, progress notes, CXR, lab work, current diet, prior speech notes, and any other information you might find useful in order to get a full clinical picture of the patient’s status and risk factors. Calling the family can be helpful if you cannot find any baseline information in the chart. 

Speak to the interdisciplinary team

Talk to the nurse, the doctors, and any other team members to find out if it is appropriate to see the patient at this time. I often receive consults for patients who are either completely functional or completely unconscious. Could you imagine using vital and scarce PPE for a patient that wasn’t even waking up for you? That’s why it is enormously important to communicate with the team in order to get the full clinical picture before we even go near the room.

Consider a nursing water screen

The nurses are already going into the patient’s room to give medication and take vitals. Most are hyper aware that we want to eliminate unnecessary use of PPE and minimize the risk of spreading the infection. In light of this, I have found the nurses extraordinarily helpful in providing the first PO trials for the patient and detailing their tolerance at bedside. If a patient passes the water screen or is tolerating a baseline diet then we should question what additional value a swallow evaluation might provide at this time. 

Benefits vs Costs 

Do your due diligence to determine if the potential benefits of your evaluation outweigh the potential costs of entering a patient’s room. Is the SLP an essential team member? When a patient is recently extubated, without AMN, at risk for malnutrition, and presenting with dysphagia then yes, of course we are essential staff and this is an essential evaluation. The medical team consulted you for a reason; they need your expertise in order to make the correct clinical decision. However, this is not the time to be the hero so everybody can see how important you are. We can bring a lot of value to the medical team from outside the room too if needed. An extraordinary situation requires extraordinary measures. With a simple and straightforward plan in place, we are much more likely to address the needs of the patient in a way that is effective and safe for everybody involved.

LINKS OF INTEREST

The author would like to mention a charity: Frontline Responders Fund: getting supplies (masks, gowns, gloves and other critical supplies) to protect medical professionals in hospitals across the world. For more information and to contribute to this fund, please visit the GoFundME Page Here: https://www.gofundme.com/f/frontlinerespondersfund

Please follow George Barnes on Instagram @dysphagiadude

Something positive to come about in the era of COVID-19 is that it has made a closely knit SLP community even closer. Thank you to all of my colleagues and friends in this great field for collaborating with me on these issues. “Alone we can do so little. Together we can do so much” – Helen Keller.

If you would like to collaborate with your SLP community consider joining Dysphagia Dialogues, a free discussion group about difficult and complex topics such as this one. Visit: https://www.feesibleswallowsolutions.com/

References

World Health Organization: Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. (2020, March 29). Retrieved April 1, 2020, from https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Swift , D. (2020, March 29). Survey Shows Just How Dire PPE Shortages Are at Many Hospitals. Retrieved March 31, 2020, from https://www.medscape.com/viewarticle/927728

Previous articleHarnessing the power of motivational interviewing in dysphagia therapy
Next articleCovid-land, NYC: Reflections from the front lines
George Barnes, MS, CCC-SLP
George Barnes MS CCC-SLP has clinical experience in a variety of settings including acute care, acute rehab, skilled nursing and long term acute care. This variety has developed his specialization in dysphagia management with a focus on diagnostics through instrumental swallow evaluations. His concentration is on geriatric patients with complex medical status. He is the co-founder of FEESible Swallow Solutions, a mobile speech pathology company dedicated to improving access to high quality dysphagia services for patients in the skilled nursing setting. He has a track record of supporting the field of speech pathology by paying his knowledge forward to other professionals via graduate level education, clinical fellowship and student supervision, the Student to Empowered Professional (STEP) mentorship program, ASHA special interest groups, peer review for ASHA course material, the SIG13 dysphagia editorial committee, and participation in various interdisciplinary teams and committees in the hospital setting. He is a multiple ASHA ACE Award recipient for his dedication to continuing education. George actively conducts and supports new research aimed to improve efficiency and accuracy in dysphagia diagnostics, management, and care.

3 COMMENTS

  1. The Speech Language Pathologist is Never mentioned in any press conference or news talk show.
    Never thanked. We are non existent to considered an “other or visitor “. I have been a Speech Language Pathologist High profiled to the media particularly being Black and never married known to the world literally because of my 39 year career marketing our profession. We are not considered essential. Our stringent required academic training regiment, our confidence and professionalism is just overwhelming to most people and the root of abusive jealousy. In 2020 we still are not valued or possibly not even the very vulnerable patients we provide trained compassionate communication and swallowing service.
    Paula Stone,M.S.,C.C.C.-SLP Naperville,Illinois 04/11, 2020 11:08 am cst

  2. Hello, Barnes

    Very interesting this “coffee break article”. I am a SLP student currently in my third semester. As I was reading, I asked myself so many times… are we really essential? And I answered very confident, yes. Currently, I don’t need a “Thank you” or some recognition to feel proud of the profession that I chose. As you say, we are not heroes and we are in high risk of anything around COVID19. As an SLP working directly with patients with COVID19, in addition of the 3 steps screening process, what else would you work on before doing the first approach with the patient?

    • Thank you for your thoughtful comment! There is a lot we can do in our chart review, discussion with our IDT, and interview with the family. We must have the full picture with a hypothesis of the patient’s risks and how the patient will do before we enter the room. With a systematic approach, we can do more in less time and improving the accuracy of our assessment and ultimately the effectiveness of our intervention.

LEAVE A REPLY

Please enter your comment!
Please enter your name here