Dysphagia Management in the Emergency Department: Using Concept Mapping to Identify Actionable Change to Improve Services

Abstract

Background: Integrated speech-language pathology (SLP) services within the emergency department (ED) may facilitate timely dysphagia management. However, there are multiple patient and logistical factors specific to the ED that challenge the delivery of optimal dysphagia referral and management practices within this setting. The aim of the current study was to engage a stakeholder group to identify prioritised, actionable goals that could help enhance dysphagia management within the ED.

Methods and procedures: Applying concept mapping methodology, 16 ED stakeholders from SLP, medical, nursing, and leadership participated in semi-structured interviews to develop action statements which were sorted and ranked for importance and changeability. Multidimensional scaling and hierarchical cluster analysis were used to organise data in clusters with unifying themes before statements were ranked by importance and changeability.

Outcomes and results: Stakeholders identified 53 unique statements, grouped into 8 clusters. Review of the 8 clusters identified 3 overarching aspects for change: (a) Improving processes related to identification and referral of patients as well as communication; (b) Teamwork and collaboration amongst the ED multidisciplinary team and SLP; and (c) Improving staffing and access to training resources for SLP and nursing teams. Seventeen statements were within the Go-zone rated highest for importance and changeability) with the highest rated statement being: Clear documentation by SLP re: recommendations.

Conclusion: The current data identified multiple aspects of service provision that require change to facilitate improved dysphagia referral and management services in the ED. Collaborative actions are required by both SLP and the ED multidisciplinary team to help optimise dysphagia services.

Keywords: Concept mapping; Dysphagia; Emergency department; Speech-language pathology; Swallowing.

Fig. 1

Dendrogram of meaningful cluster themes

Fig. 2

Cluster rating map for each cluster theme (by importance)

Fig. 3

Pattern matching comparing importance and changeability of clusters

Fig. 4

Go-zone plot illustrating the plot of all statements across importance and changeability. The position of the statements is determined by the average ratings for importance and changeability. Zone A: Highest changeability; lowest importance ratings; Zone B (Go-zone): Highest changeability; highest importance ratings; Zone C: Lowest changeability; lowest importance ratings; Zone D: Lowest changeability; highest importance ratings