Interdisciplinary Training for High-Risk Telehealth Consultations in Care Homes

There is increasing positive evidence that conducting telehealth assessments for swallowing difficulties or dysphagia improves clinical outcomes and may provide new service models in care homes (1–4). Care Home staff are accustomed to receiving training on dysphagia management via face to face training and e-learning modules (5-6). However, most clinicians have not received formal training on using telehealth and do not feel confident integrating this into practice (7) A training package was developed to meet the essential competencies to safely practice remote dysphagia assessments in an integrated context. This project aims to evaluate the training program that provided clinical, technical and telehealth skills to be able to conduct remote dysphagia telehealth consultations in care homes. The training program includes clinical components from Speech and Language Therapy, Dietetics, and Pharmacy in addressing swallowing, nutrition, and medication management of care home residents with swallowing difficulties. In addition, we have provided a telehealth training program to include the general components of the telehealth consultation (8). We also used role plays to replicate real cases in care homes. Interviews and self-reported questionnaires were gathered before and after the training to gauge the participants’ confidence levels. There has been a significant increase in confidence after the training across clinical and telehealth competencies. Role plays help care home staff to effectively apply interdisciplinary clinical skills, practice technical components, and problem-solve potential issues with no risk to residents. The training also provided opportunities for discussion regarding giving precise instructions, information gathering before the session, and safe practices, including safeguards and emergency plans. Training both clinical and telehealth competencies aids in increasing confidence in conducting multidisciplinary dysphagia assessments in care home settings. Ward EC, Sharma S, Burns C, Theodoros D, Russell T. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation. Dysphagia. 2012;27(4):460–72. Ward EC, Burns CL, Theodoros DG, Russell TG. Evaluation of a clinical service model for dysphagia assessment via telerehabilitation. Int J Telemed Appl. 2013;2013. Ward EC, Burns CL, Gray A, Baker L, Cowie B, Winter N, et al. Establishing Clinical Swallowing Assessment Services via Telepractice: A Multisite Implementation Evaluation. Am J Speech Lang Pathol. 2021;30(6):2456–64. Brodsky MB, Gilbert RJ. The Long-Term Effects of COVID-19 on Dysphagia Evaluation and Treatment. Arch Phys Med Rehabil [Internet]. 2020;101(9):1662–4. Available from: https://doi.org/10.1016/j.apmr.2020.05.006 Pownall S, Barnett E, Skilbeck J, Jimenez-Aranda A, Fowler-Davis S. The development of a digital dysphagia guide with care homes: Co-production and evaluation of a nutrition support tool. Geriatrics (Switzerland). 2019;4(3). RCSLT. Royal College of Speech and Language Therapy Guidance on the Management of Dysphagia in Care Homes 1. Royal College of Speech and Language Therapists [Internet]. 2014;1–13. Available from: https://www.rcslt.org/-/media/Project/RCSLT/guidance-on-the-management-of-dysphagia-in-care-homes.pdf Malandraki GA. Telehealth Recommendations for Dysphagia Management during COVID-19 – Purdue I-Eat Research Lab [Internet]. Purdue I-EaT Lab. [cited 2022 Jun 15]. Available from: https://www.purdue.edu/i-eatlab/telehealth-recommendations-for-dysphagia-management-during-covid-19/ 8 Lum E, van Galen LS, Car J. Competency-Based Training for Entrustment in Telehealth Consultations. Pediatr Clin North Am. 2020;67(4):735–57.