Speech and Language Therapy clinical outcomes

Clinical outcomes are broadly agreed, measurable changes in health or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.

About the Speech and Language Therapy service

The Speech and Language Therapy (SLT) Service at Great Ormond Street Hospital (GOSH) works in partnership with many of the hospital’s clinical specialist services (e.g. cleft palate, ENT, craniofacial and epilepsy services) to provide specialist SLT assessment of a child’s communication and feeding skills. We will see patients in both multi-disciplinary and uni-disciplinary clinics. Our assessment may involve diagnostic tests not available to local services and our SLTs have specialist knowledge and skills in working with children with rare conditions.

75 per cent of the services we provide are delivered within the outpatient setting. 90 per cent of our appointments are focused around the assessment of a child. Specialist SLT assessment is provided in order to determine the nature of the child’s communication and/or feeding difficulty, the likely prognosis, and the most appropriate management of their condition. We work closely with the child’s local team to ensure that our assessment findings are communicated clearly and have value to the child’s on-going care. In the majority of cases, it is appropriate to refer a child back to the local provider service with recommendations for treatment. 

Clinical outcome measures

1. Were your questions answered? A Patient-Reported Outcome Measure for SLT outpatients

The primary focus of our care is to provide information to referrers and families. This may include information about the child’s specific speech and language or feeding diagnosis, the impact of any underlying medical condition on communication and/or feeding, the likely impact of any planned intervention on communication or feeding skills, and recommendations for specific speech and language therapy interventions.

We consider it of great importance that any questions a family has about their child’s communication or feeding difficulties are answered as clearly and comprehensively as possible at the time of their visit(s).

We developed the ‘Were your Questions Answered?’ outcome tool in 2012 to evaluate the extent to which families find the information we provide to be helpful in understanding their child’s condition and in supporting their child. The tool asks families to record the questions they wish to be answered during their consultation and to rate how well each question has been answered at the end of the consultation using a scale from 1 (not at all) to 5 (very well). Questionnaires are submitted to reception anonymously as the patient leaves the clinic. 

Results

We received 93 completed questionnaires for the month long survey period in 2014. 99 per cent of families rated the service as answering their questions ‘5 - very well’ (87 per cent) or ‘4 - well’ (12 per cent). Less than 2 per cent of families rated the service as answering their questions as ‘3 – okay’, and none rated the service as a 2 or 1. This year’s results showed an 8 per cent rise in questions rated 5, and a 5 per cent rise in questions rated 4 or above from last year’s study.

The average rating across all questions that were scored was 4.9 (Scale 1-5). This continues to build on the successful results of the 2013 audit, which yielded an average score of 4.7.

SLT PROM results 2014
SLT PROM results 2014

27 per cent of questions related to the nature and cause of a child’s communication and/or feeding difficulties, but parents also asked about appropriate support (17 per cent), future expectations (16 per cent), treatment options (15 per cent) and progress made (13 per cent). See Figures 1 and 2 for detail.

Figure 1: Types of questions asked by our patients and families

Types of questions asked by our patients and families
Types of questions asked by our patients and families

Figure 2: Percentages of scores by question type

Percentage scores by question type
Percentage scores by question type

We also analysed scores by clinics for: Beckwith-Wiedemann syndrome; Cleft Lip and Palate; Cochlear; Craniofacial; Ear, Nose and Throat; and Dysphagia.

Figure 3: Percentages of scores by condition

Percentage scores by condition
Percentage scores by condition

The results from the audit show a consistently high - and improving - level of service delivery and patient/family experience.  We plan to repeat this audit annually to review our practice and ensure that we continue to provide a high quality service to patients and their families.