Clinical outcomes are measurable changes in health, function 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 specialist clinical 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.
70 per cent of the services we provide are delivered within the outpatient setting. 90 per cent of our appointments are focused on 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 ongoing care. In the majority of cases, it is appropriate to refer a child back to the local service with recommendations for treatment.
Clinical outcome measures
1. How well 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 ‘How well were your Questions Answered?’ (How-QA?) 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.
We received 84 completed questionnaires for the month long survey period in 2018. 98 per cent of families rated the service as answering their questions ‘5 - very well’ (85.5 per cent) or ‘4 - well’ (12.5 per cent). Fewer than two per cent of families rated the service as answering their questions as ‘3 – okay’; ‘2 – not well’, or ‘1 – not very well’. This year’s results showed a consistent level of ratings from studies done in 2016 and 2014, with over 90 per cent of families rating questions at 5 or 4 across all three years.
The average rating across all questions that were scored was 4.8 (Scale 1-5). This continues the successful results since the 2014 audit, which yielded an average score of 4.9.
Fig. 1 Average rating across all questions
22 per cent of questions related to long-term and future expectations but parents also asked about the nature and cause of a child’s communication and/or feeding difficulties (19.5 per cent), progress made (15.5 per cent), appropriate support (14.5 per cent), and treatment options (13.5 per cent). See Figures 2 and 3 for detail.
Fig. 2 Types of questions asked by our patients and families
Fig. 3 Percentages of scores by question type
We also analysed scores by clinics for: Beckwith-Wiedemann syndrome; Cleft Lip and Palate; Cochlear; Craniofacial; Dysphagia; Ear, Nose and Throat, and Neurodisability.
Fig. 4 Percentages of scores by condition
The results from the audit show a consistently high level of service delivery and patient/family experience. We plan to repeat this audit every two years to review our practice and ensure that we continue to provide a high quality service to patients and their families.
This information was published in August 2018 and will be updated in August 2020.