• Why you are referring the patient, urgency of the consult and document it in the consult request.
• Is the patient about to be discharged? Is patient NBM?
• Is the patient alert and suitable to be fed?

JMOs can contact the Speech Pathologist if unsure whether a referral is appropriate.

• Patient’s admission history including current chest status and any premorbid texture modified diet/fluid restrictions or communication deficits.
• Previous medical history (particularly any neurological, respiratory, head and neck history) including any pre-existing swallowing or communication difficulties and any oesophageal/gastro history.

• If concerns re: signs/symptoms of dysphagia or aspiration, then referral to Speech Pathologist indicated. If the patient has had a stroke/TIA, then the ASSIST swallow screen can be completed by a trained member of the team.
• Information from CT Brain/MRI, chest x-rays if concerns about aspiration and gastro reports/scopes can be valuable depending on the case.

• Be aware of the role of Speech Pathologists – we see patients for communication, speech, swallow and voice disorders.
• If referred for swallowing, noting whether method of taking medication can be changed or not if needed.
• Previous Speech Pathology input either prior to or during current admission (check eMR).
• If the identified issues are acute or chronic.
• Know the difference between, aphasia, dysarthria and dysphagia.
• Know the difference between a modified barium swallow (videofluoroscopy) and a barium swallow.

• Ensure patient is appropriate for assessment – that is, alert, can manage own secretions, not fasting for other reasons e.g. surgery, GI reasons.  Consider appropriateness to refer to other subspecialties.
• Reason for referral is often not on the consult sheet.
• Thickening fluids are not necessarily safer for every patient, and placing someone on thickened fluids without a Speech Pathology assessment may be placing a patient at risk.
• Referring oesophageal dysphagia to Speech Pathologist.
• Referring for difficulty swallowing tablets, when the patient is managing food and fluid fine. In this case medications may be able to be modified rather than referring to speech pathology. Call for advice.