Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia.
Australian Catholic University, School of Allied Health, Brisbane, QLD, Australia.
Int J Lang Commun Disord. 2024 May-Jun;59(3):963-975. doi: 10.1111/1460-6984.12976. Epub 2023 Nov 3.
Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions.
METHODS & PROCEDURES: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey.
Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events.
CONCLUSION & IMPLICATIONS: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.
What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.
语音治疗第一联系点诊所（SLT-FPOCC）模型可协助评估转介至耳鼻喉科（ENT）服务的低风险患者人群。为了进一步改善 ENT 候诊管理并遵循最佳护理实践，需要考虑其他可通过此服务模型安全管理的低风险人群。本文的目的是评估在 SLT-FPOCC 模型中完成甲状腺/甲状旁腺手术后患者声带检查（VCC）评估的临床和服务结果，并检查消费者的看法。
该服务遵循现有的 SLT-FPOCC 程序，ENT 分诊转介，然后由 SLT 完成术前和术后 VCC 评估（访谈、感知评估、软性鼻内镜检查），然后由 ENT 审查评估数据以诊断喉病理。前瞻性收集临床和服务结果。患者完成了匿名服务满意度调查。
在第一批 100 名转介进行术前 VCC 的患者中，SLT 评估发现 42 例有发声障碍，30 例报告有吞咽困难，而 ENT 则证实 9 例有明显的术前解剖学发现。83 例患者接受了手术，其中 63 例（95 例神经处于手术风险中）返回进行术后 VCC。术后 VCC 发现 3 例暂时性神经损伤（3.2%）和 3 例单侧声带麻痹（3.2%）。患者对该服务非常满意。所有 163 例术前/术后 VCC 均完成，无不良事件发生。
目前的数据支持 SLT-FPOCC 服务扩展，包括甲状腺/甲状旁腺手术后的 VCC 检查，同时具有积极的消费者认知。该模型支持为接受甲状腺/甲状旁腺功能障碍手术的患者提供最佳管理实践（即术前和术后 VCC），并为 ENT 服务提供相关效率。
已经知道什么：通过软性鼻内镜评估喉功能是推荐的甲状腺/甲状旁腺手术后最佳实践，因为喉返神经损伤的发生率较低（<10%），但这是这些手术的公认风险。传统上，普外科医生将术前患者转介给 ENT 进行声带检查（VCC）评估。然而，随着专科门诊服务的压力越来越大，越来越多的人支持利用其他卫生专业人员，如在第一联系点（FPOCC）模型中工作的言语治疗师，协助管理此类低风险人群的术前和术后评估。本文增加了什么：这项工作扩展了新兴的语音治疗（SLT）领导的 ENT 门诊服务中的 FPOCC 模型的证据基础，提供了临床和服务结果，以支持为新模型提供安全性，该模型旨在为甲状腺/甲状旁腺手术后的患者进行 VCC 检查。采用类似于之前发表的 SLT 领导的 FPOCC 模型的类似模型，训练有素的 SLT 完成术前和术后 VCC，包括软性鼻内镜检查和频闪喉镜检查，并将图像和临床信息提交给 ENT 进行诊断和管理计划。本研究还提供了关于这种服务模式的消费者认知的第一数据。这项研究的临床意义：对 100 例连续术前患者的数据显示了积极的服务发现，支持该模型的安全性。手术前后的临床发现的性质和发生率与使用传统护理模式（即 ENT 完成软性鼻内镜检查）的研究一致。消费者的看法是积极的。该模型能够为接受甲状腺/甲状旁腺手术的患者提供术前和术后评估，符合最佳护理实践，并减轻 ENT 服务的负担。该模型避免了总共 163 次 ENT 预约，对 ENT 候诊管理有积极影响。
