Improving the Care of Patients with Communication-Related Disabilities in an Acute Care Setting

From the 2022 HVPA National Conference

Daniel Yusupov B.S. Neurobiology, University of Washington, Class of 2016 (Lewis Katz School of Medicine at Temple University), Xin (Linda) Zhou M.D.

Background

Patients present to the hospital who are unable to communicate through speech for a multitude of reasons ranging from chronic communication-related disabilities to acquired loss of speech from acute insults such as stroke, seizure, trauma, intubation, and more. Medical teams of doctors, nurses, and other hospital staff have trouble communicating with these patients and providing high-quality care. These patients are often left out of critical medical decision making and are more likely to experience adverse events during their hospital stays. There are increased hospital costs and resource utilization that result from longer hospital admissions, increased rate of readmissions, and increased ordering of labs and imaging to compensate for communication breakdowns. Augmentative and Alternative Communication (AAC) and Assistive Technology (AT) offer tools which may help bridge gaps in communication and re-integrate patients into medical decision making. However, we see an underutilization of these tools at Temple University Hospital (TUH).

Objective

This quality improvement (QI) project focuses on the processes surrounding the delivery of AAC/AT tools to patients who are non-speaking within the neurology department at TUH, in hopes of improving the care we provide these patients and creating a more equitable healthcare delivery system. The aim of this QI project is to increase the percentage of patients with communication-related disabilities who are able to communicate their needs to their care teams to 60% by the end of April 2022.

Methods

The Plan-Do-Study-Act (PDSA) method of improvement was used in this study. Baseline data was acquired using a combination of survey data and data acquired through EPIC to understand current systems that are in place to support patient communication needs. Based on that baseline data, the interventions proposed in this study were to increase documentation of communication recommendations by speech language pathology (SLP) as well as the documentation of these communication strategies by neurology residents. We had an interdisciplinary team consisting of one neurology resident and one speech language pathologist.

Results

Baseline data surveying neurology residents showed large variability in the approaches taken to facilitate communication with patients. Just over 50% of residents indicated that they would consult speech language pathology (SLP) for a communication evaluation. Zero (0) out of the seven (7) residents had heard of AAC/AT, and four (4) out of seven (7) had heard of communication boards before. Prior to implementing our intervention, zero percent (0%) of neurology patients with communication deficits felt as though they were able to communicate their needs to their care team. After implementing our intervention, that number went up to 60%.

Conclusion

The aim of this improvement project was achieved. Despite its limitations, this study proposes a model to standardize how we approach communication at TUH and would increase the data available on AAC/AT utilization for future studies. Ultimately, this brings us one step closer toward building a culture of communication access at TUH.

Clinical Implications

This initiative put communication on the forefront of the care team’s mind. By ensuring that every patient is able to communicate their needs with their care team, patients are able to re-integrate into medical decision making, physicians are able to provide higher-quality care, and hospitals are able to save on costs.

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