I am a specialist speech and language therapist (SLT) working in the NHS. I have a special interest in voice and work closely with the ENT laryngologist. I attend joint flexible laryngoscopy clinics twice a week and contribute to the assessment and management of voice symptoms. Voice disorders can be categorised as structural, inflammatory/neoplatsic, neurological and functional (McGlashan, classification). Our clinic is a specialist clinic accepting tertiary referrals and there has been rise in the number of referrals to this clinic with associated increased waiting times. The outcome of these clinics can vary from surgical investigation and management, referral for voice therapy via SLT, referral for other diagnostics ie CT/MRI, referral to another health professional for same condition or advice and discharge.
Earlier this year I was successful in applying to the NES AHP Career Project-based Fellowship. My aim is to pilot an SLT-led flexible laryngoscopy service for the assessment and management of patients with new voice symptom. This will be based on selection criteria to identify patients at low risk and who are most likely to require voice therapy as their primary mode of treatment. This new clinic will run in addition to the joint clinic and be a new clinic to triage patients into.
This project will contribute to local and national strategies and priorities contributing to advanced practice and contribute to the national approach for Nursing, Midwifery and Allied Health Profession Transforming Roles Strategy. It will raise the profile of SLT within our ENT directorate and provide opportunity for career progression within the profession. It will aim to demonstrate how SLT can utilise the skills of performing video-nasendoscopy and the examination and interpretation of the larynx at a time of increased pressure on waiting times, patient pathways and most importantly quality intervention.
In order to set this clinic up I required support from key stakeholders including ENT and SLT. Setting up the clinic has developed my leadership skills and the initiation of quality improvement and developing systems to capture the data we are producing from this clinic. Whilst there is a high degree of clinical autonomy, I work within my scope of practice and have regular clinical case discussions and supervision. I have the full support of the laryngologists and we review the images and diagnosis with a high inter-rater reliability of interpretation, diagnosis and management plan.
I am currently half way through the project and the outcomes from the clinic are demonstrating that clear referral criteria are important to direct appropriate patients to this clinic. These can be reflected in the outcomes from the appointments to date, showing 56% requiring SLT as primary mode of treatment, 35% requiring no further action and 9% required referral back to the laryngologist.
We are also observing that the patients we see in the ENT/SLT joint clinic are now predominantly more complex patients requiring multidisciplinary input or surgical management. We anticipate that this is due to the SLT clinic seeing patients who are less complex and are likely to require either basic advice or SLT therapy. This will support how SLTs working within an advance practice role support increased capacity and capability within ENT.
This fellowship opportunity has allowed me progress my learning across the 4 pillars of clinical practice: leadership, education and research. In order to carry out this project I was required to demonstrate my ability and competence to level 3 endoscopic evaluation of the larynx as per the Royal College of Speech and Language Therapy guidelines. I did this by spending time at a specialist department in North England who already use this pathway in the management of voice disorders and link in with highly experienced SLTs to provide supervision specific to working with ENT.
The next steps are to complete the pilot clinic, review and evaluate all the data collected in the pilot clinic and carry out a service needs analysis and business case. I will also be evidencing the learning opportunities and personal development during this time.
Georgina Parkinson (Band 7 SLT) twitter @georgievoice
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