Interdisciplinary solutions to low value care in nutrition and dysphagia

When their existing models of care were identified as time intensive and causing delays in patients receiving the appropriate care, RBWH’s Nutrition and Dietetics and Speech Pathology departments came up with new innovative models of care.

The new models take an interdisciplinary approach to nutrition and dysphagia care, freeing up dietitian’s and speech pathologist’s time to focus on patients who can benefit most from their help and reducing the requirement to see patients that don’t require their expertise.

Previously, blanket models of care for allied health staff were time intensive and often had no clear evidence of benefits to patients. For example, patients would require a dietitian review before commencing nasogastric feeding, and head and neck cancer patients were required to have a weekly review by a speech pathologist during radiation treatment, regardless of their risk of swallowing difficulties.

For the hospital, it meant the allied health staff were stretched, with less time to focus on high-risk patients. With the increasing demand for service, these models of care were not sustainable. The Nutrition and Dietetics and Speech Pathology teams shared that the problem was easily identifiable, but that the solution required teamwork to ensure patients were able to receive patient centred care in a timely manner.

Led by Dieticians Claire Dux and Jo Hiatt, the RBWH Nutrition and Dietetics team implemented a new process whereby nasogastric feeding protocols are started by the frontline clinical team without needing to wait for dietitian review.

“Our nasogastric feeding protocols have been expanded across RBWH, with recent audits showing that 80 per cent of patients now receive their nutrition via these protocols,” she said.

“This represents a huge time saving for dietitians, which in turn avoids any delay with providing patients with the nutrition they need.”

As part of her PhD studies, Dr Laura Moroney from RBWH Speech Pathology worked with her team to introduce risk screening during the standard dietitian assessment for a subset of patients identified as low risk, with referrals to speech pathology only where swallowing difficulties were identified.

“Our study confirmed only 10 per cent of patients identified as low risk for dysphagia required specialist speech pathology intervention and our screening methods were effectively identifying those patients,” she said.

“This has allowed us to direct our time to those patients with head and neck cancer who really need our help.”

These innovative models of care have been published in scientific journals and have been shared within state-wide nutrition and speech pathology networks to promote revision of nutrition and dysphagia models of care across Queensland.