a handbook for supervising allied health professionals - HETI - NSW ...

Transfer of a patient to an external facility for rehabilitation from one speech pathologist
to another.
Introduction: Hello I am (name), speech pathologist calling from the acute stroke unit at
the Royal Hospital. I am calling to hand over care of Mr Smith who is being transferred to
the rehabilitation ward at your facility this afternoon. Will you be the person managing him
in rehab
Situation: Mr Smith is a 78 year old gentlemen who currently has moderate
oropharyngeal dysphagia, and moderate dysarthria affecting intelligibility in conversational
speech. His language is functional but mild aphasia is present. He is currently on a
modified minced diet with nectar fluids, is taking medication orally and his chest is clear.
He has right upper and lower limb weakness affecting his ability to self-care, including
feeding himself. He requires the assistance of one person to mobilise with a transfer belt
and assistance of one for self care.
Background: The patient presented at Emergency on 31 May 2011 with slurred speech
and right upper limb weakness. The CT showed the presence of a left middle cerebral
artery thrombolytic stroke. The patient has a history of high LDL cholesterol, IHD and
diabetes. He is retired and was previously living independently at home with his wife who
is fit and well. He has a supportive son who lives nearby.
Assessment: A swallowing assessment from speech pathology demonstrated a weak,
delayed swallow and high aspiration risk. A subsequent modified barium swallow (MBS)
was conducted, resulting in him being placed on a modified minced diet with nectar fluids
due to delayed swallow with pooling in the pharyngeal valleculae leading to aspiration
risk. He has also been receiving dysarthria therapy once a day directed at improving
intelligibility while in the acute stroke unit. The family has been present during therapy
sessions and are keen to participate in the treatment plan for the patient to assist return
to independent function. Based on his recent MBS, the patient continues to require a
modified diet, but is keen to progress to normal fluids as soon as possible.
Recommendation: Based on his risk of aspiration and ongoing speech difficulties,
Mr Smith would benefit from therapy to improve oro-facial muscle tone, conversational
speech intelligibility and a possible repeat MBS prior to progressing to thin fluids. It is
recommended that Mr Smith undertake a period of inpatient rehabilitation to achieve his
goals of enhanced swallowing function and improved speech quality. A follow up MBS
may also be required.
Thank you for taking over care of this patient. I have completed a detailed discharge report
which I will fax over to detail the treatment plan to date and recommendations. A separate
MBS report will also be attached. Do you have all the information you need to take
over care of this patient Please don’t hesitate to page/phone me if you require further
information.
SECOND EDITION
Example: handing over by phone with ISBAR
HETI
THE SUPERGUIDE
51