“An innovative use of technology that significantly enhances the use of limited NHS resources by reducing costs, saving time, improving productivity and increasing capacity while enhancing the quality of care experienced by the patient.”

Watch this short two minute video about Teleswallowing®

THE PROBLEM

 

Swallowing difficulties (dysphagia) may precipitate aspiration pneumonia, malnutrition, poor rehabilitation, hospital admittance, increased length of hospital stay and a reduction in quality of life. It is an independent predictor of poor patient outcome and death.

National Clinical Guidelines for good practice support early identification, assessment and management of dysphagia in order to facilitate better patient outcomes, reduce mortality rates and long-term costs.1

Dysphagia is prevalent among the elderly, is a frequent corollary of neurological disease particularly following stroke and in the end stage of dementia and so is common among care home residents.

There are 426,000 elderly and disabled people in residential care2. Between 50-75% of nursing home residents have dysphagia3.

Assessment of care home residents’ swallowing by a Speech and Language Therapist (SLT) currently requires attendance at an out-patient facility or care home visits by the SLT.

Attendance at out-patient clinics require carer supervision, hospital transport, inconvenience and stress for elderly and infirm patients and missed appointments waste considerable SLT time.

Care home visits by the SLT are an inefficient use of NHS time and resources.

Delays in the identification, assessment and management of dysphagia due to staff shortages, work patterns and waiting lists can cause the deterioration of a care home resident’s health and the subsequent hospital admission could have been avoided if dysphagia had been assessed and managed at the point of need.

 

“I like the fast track. It minimises the delay of assessment and implementing a plan to reduce distress to patients and residents.”

Nurse

THE SOLUTION

 

Teleswallowing® is an innovative use of telemedicine whereby the SLT can rapidly and accurately assess a care home resident’s ability to swallow remotely, without the need for face-to-face assessment. Similar services are already being used successfully in both Australia and Canada.

Teleswallowing® has been proven to work as a highly efficient clinical tool in the Blackpool Teaching Hospitals NHS Foundation Trust speech and language department.

The initial results indicate that Teleswallowing® removed the need for patients to receive a care home visit and none were admitted to hospital with the following benefits for the Trust:

  • 100% diagnostic accuracy for diet and fluid modification compared to bedside assessment
  • Projected annual cost-efficiency of £856,904.88
  • 79.5% reduction in cost per patient compared to home visits
  • 98.5% reduction in cost per patient where early assessment and treatment provided by Teleswallowing® prevents deterioration in patient health and subsequent admittance to hospital
  • 66% reduction in time taken to assess each patient compared to home visits
  • 50% reduction in time taken to assess each patient compared to bedside assessment in hospital
  • Improved response time to referrals
  • Improved quality of service for patients and care homes
  • The increase in care home staff knowledge and awareness of dysphagia improved their early identification of dysphagia symptoms
All the above were achieved with no loss of rapport between patient and SLT and no reduction in diagnostic accuracy.

Teleswallowing® benefits all stakeholders:

  • Patients benefit from faster assessment in the comfort and convenience of their residential surroundings
  • Care homes can demonstrate that they are providing state of the art technology in the care of their residents
  • SLT departments benefit from long term time savings
  • Clinical Commissioning Groups (CCGs) benefit from long term cost savings

“We thought there would be a lack of personal touch but we found that this was not the case.”

Speech and Language Therapist

OBSTACLES

 

For remote assessment of swallowing to succeed, it is essential that cost-effective, high quality audio-visual facilities are provided. Remote assessment requires:

  • Adequate internet connection, particularly in bandwidth-challenged areas, to ensure the SLT can see and hear the patient uninterrupted for the duration of the remote swallowing assessment and the patient can see and hear the SLT so there is no loss of rapport
  • Diagnostic quality video and audio to ensure the SLT can clearly see and hear the patient on their computer monitor with sufficient clarity to accurately assess and diagnose the patient
  • Adequate security and encryption to ensure all communication is confidential
It is unlikely that any care home’s existing IT infrastructure will be adequate to support the implementation of remote assessment of swallowing and it is likely that SLTs  will lack the knowledge and experience to be able to implement a service as cost-effectively and efficiently as possible.

THE TELESWALLOWING LIMITED SERVICE

 

Teleswallowing Limited use their experience and expertise to project manage the implementation of Teleswallowing® throughout the NHS. This avoids each SLT department wasting valuable resources working out how to implement remote assessment themselves.

Teleswallowing Limited commission an IT survey of a care home to ensure the most appropriate and cost-effective IT hardware and software is installed. Teleswallowing Limited then train the SLTs how to use the equipment and how to train the care home staff. Once Teleswallowing® is successfully implemented in one care home, it can be rolled out to other care homes by the SLT department or by Teleswallowing Limited.

Once adequate IT software and hardware is installed in a care home, it is conceivable that it could also be used by other healthcare practitioners such as Occupational Therapists, Physiotherapists, Dietitians, Nursing and Medical Staff, etc to remotely assess and manage care home residents’ other health needs leading to significantly greater cost-efficiencies for the NHS.

 

“Nursing Home staff have increased knowledge when they discuss clients on the phone. They are more knowledgeable and this makes the case discussions more effective and less risky.”

Speech and Language Therapist

PROFESSIONAL ENGAGEMENT

 

The Royal College of Speech and Language Therapists (RCSLT) are familiar with the Teleswallowing® agenda.  The Teleswallowing Limited directors instigated a steering committee for RCSLT’s national campaign to facilitate the profession’s “digital shift”.  This will embed this enhanced service delivery model into the national conscience.

NATIONAL ENGAGEMENT

 

This augmentative Teleswallowing® service delivery model is commensurate with the Government’s NHS Business Plan 2015-2016: delivering value and sustainability through a step-change in efficiency; developing capability and infrastructure for transformational change; developing leading edge science and innovation; supporting patient and public participation; enabling whole system change; strengthening primary care services and harnessing the information revolution.

It also meets with the Government’s Quality, Innovation, Productivity and Prevention (QIPP) challenge to the NHS to deliver an improved quality health care via innovative service delivery whilst also improving productivity and increasing cost efficiency.

THE TELESWALLOWING LIMITED TEAM

 

Veronica SouthernVERONICA SOUTHERN, Director, is a Speech and Language Therapist with a M.A. in Health Research.  She was awarded Highly Commended for the NHS Challenge Prize in Rehabilitation. She is currently Clinical Lead in Telesolutions in a UK hospital trust.  She has developed the use of computer therapy for post-stroke communication and has co-designed the Teleswallowing® approach from initial concept to a clinical tool. She is a regular contributor and presenter at conferences and is working with the Royal College of Speech and Language Therapists to develop the use of technology within the profession.

 

Liz BoadenDr ELIZABETH BOADEN, Director, a Fellow of the Royal College of Speech and Language Therapists, is Clinical Lead for dysphagia in a UK hospital trust and a Senior Research Fellow at a UK university. She is an honorary lecturer at post-graduate level on specialist and advanced courses at four universities, as well as presenting at national and international conferences.  Liz is co-author of Swallowing Guidelines: Individualised Programmes of Care and lead researcher and co-author of the Inter-professional Dysphagia Framework. Liz is a founding tutor and lecturer of the internationally-renowned Manchester Post Basic Dysphagia Course and has co-designed the Teleswallowing® approach.

FURTHER INFORMATION

For more information on the Teleswallowing Limited solution, please contact us.

References

1ICSWP, 2012; NICE: Swallowing screening and nutrition management; CG42 Dementia, 2006

2Care of Older People Market Survey 2013/14, Laing and Buisson, 2014

3O'Loughlin, G. and Shanley, C. 1998. Swallowing Problems in the nursing home: a novel training response. Dysphagia, 13:172-183 Cited in RCSLT Resource Manual for Commissioning and Planning Services for SLCN Dysphagia (literature synthesis updated 2014)