3141 Quality improvement: integrating speech and language therapy into a hospital at home service for older people living with frailty

Abstract Introduction Oropharyngeal dysphagia (OD) affects up to 47% of older people with frailty (Tagliaferri et al., 2019). Community Speech and Language Therapy (SLT) services face challenges in identifying and addressing this need due to limited resources, poor awareness of SLT value, and workforce skill gaps. This Quality Improvement (QI) project used an A3 improvement approach to understand SLT service needs of patients and explore benefits of integrating services with frailty on the caseload of a Hospital at Home (H@H) service. Method SLT provision for H@H is 0.2 WTE and excludes time for board rounds. Four PDSA cycles tested the impact of SLT attending board rounds twice weekly to offer direct support, improve service visibility, and initiate referrals. Referral numbers and staff feedback were monitored. Concurrently, PDSA cycles developed training sessions for community staff to improve dysphagia management and referral accuracy. Metrics included participation rates and feedback. Results Referrals increased by 500%, from 2 to 12 monthly. Staff feedback highlighted enhanced interdisciplinary collaboration, improved patient outcomes, and increased access to real-time advice. One H@H staff member shared, ‘readily available to ask advice and answer questions ensuring I have the correct information to work with and provide the right care for my patients.’ Participation in SLT training rose from 0 to 21, with reported confidence improvements of 20–60%. However, SLT waiting times increased by 60% (55–88 days) due to higher referral volumes. Reliance on temporary staff underscored capacity constraints. Conclusions QI methodology can be used to integrate SLT and H@H services for older people with frailty. The project identified unmet SLT needs, improved referrals, and strengthened collaboration. SLT participation in board rounds proved most impactful. Sustaining this change requires further investment in integrated SLT services, expanded training, and streamlined workflows to enhance community care for older adults living with frailty.