Speech pathology and dietetics in a private head and neck service: opportunities, challenges and outcomes.

Abstract

Introduction / Background: In 2015, Epworth HealthCare established a head and neck service. This paper will discuss our experience with establishing a service in a private hospital setting. Our clinical cohort will be outlined and functional outcomes of our largest subgroup described. Methods: Descriptive (clinical and service) data was extracted retrospectively from local databases from August 2015 – February 2018, including outcome measures collected prospectively during clinical care. Results: 434 operations were performed, with 101 patients referred to SP / DT during their acute admission. 23 were post Transoral Robotic Surgery (TORS) for oropharyngeal cancer (18 primary, 5 salvage). Of the primary TORS cases, 100% commenced oral diet during their acute stay, scoring a FOIS of 5 or above on discharge. 100% scored 75 and above on the PSS-HN Understandability of Speech scale. 83% had NGT placement, but only 53% of these were used for feeding. Median duration of tube use was 1 day (IQR 0-6.5). 19 TORS patients were referred to our outpatient service. Mean length of service was 12 weeks (average 15.42 sessions across all disciplines). On discharge, improvements were seen in swallow, speech and nutritional measures, at or nearing pre-operative status. Outcomes were generally poorer for salvage cases, with greater tube feeding and worse speech / swallow scores. Opportunities / challenges include private health funding, no defined patient catchment areas and data collection. Conclusion: Our early learning suggests a successful multidisciplinary head and neck service in a private setting is feasible and functional outcomes comparable with current evidence.