SLPs work in various settings with people across the lifespan; typically, SLPs diagnose and treat speech, language, communication, feeding, swallowing, and voice disorders, to name a few. I enjoy acute care because no day is the same. I love the variety and new experiences, so I wanted to share a realistic day in the life of an acute care Speech Pathologist with you.
8:30 am – START THE DAY
My day begins with me doing chart reviews. Usually, the productivity requirement is 24 units for an 8 hour day, but this may depend on your facility policies—productivity measures healthcare output like the quantity and quality of care. Therapists are held accountable for the number of patients seen and the number of billable units.
This morning, my helpful and amazing coworker who arrived before me reviewed the Modified Barium Swallow Study MBSS report I completed the previous day- MBSS is instrumental in evaluating how a person is swallowing foods and liquids via X-ray/ fluoroscopy.
9:42 am – 5th FLOOR
I donned my N95 and surgical mask before heading to the floor to see the patients I triaged for the day. Triaging is a process of sorting people based on their need for immediate medical treatment. Usually, patients that are not allowed anything by mouth NPO are the priority. Once I make it to the floor of my first patient, I typically call the nurse to let them know I arrived, get an update on the patient’s current status or discuss any last-minute changes. I go to the nourishment room for that floor to grab what I need to complete my evaluation.
After completing the evaluation, I educate the patient and/or family, discuss my finding with other care providers, write my report, make diet changes if needed, and create/ print any educational material.
11:02 am – SPEECH OFFICE
I have seen a few patients by this time, and things were hectic between running around, canceled visits revisits, and conversations with care providers. Back in our speech office, I document the patients I visited that morning in our EPIC electronic medical record system. I have to fill out an evaluation report, flow sheet, education documentation, and care plan.
12:00 pm – LET’S EAT
12:36 pm -SPEECH OFFICE
I log back into the system and realize we have new consults, so I plan to see three evaluations and one MBSS for the afternoon. It looks like I have an entire afternoon, depending on how each visit goes.
Here is a list of information I want to know during my chart review.
- Pt name, age, gender
- Past medical history
- Respiratory status( room air, vent, trach, 02)
- Current medication
- Medical diagnosis
- Reason for visit or chief complaint
- Have they been seen by SLP before
- MRI and CT scan results
- Chest x-ray findings
- Recent intubation
- Current status
1:00 pm – RADIOLOGY
This patient was admitted for GI complaints. Most significantly, she has a history of GERD. Her MRI was noteworthy for Chiari 1 malformation with complaints of food feeling stuck in her throat. This patient was also Gluten and dairy-free. We don’t usually have gluten-free crackers lying around, so I had to find something suitable for the assessment. The outcome was a functional oral pharyngeal swallow, so after writing up my report, I will educate the patient and plan to discharge her from our caseload.
2:15pm – ICU Floor
This patient was intubated for two days and came in with chest pain and Pneumonia. She was pleasantly confused and required 6 liters of oxygen. This patient was alert to herself and time only with a history of swallowing difficulties, per spouse. She looked much better and showed no signs of dysphagia at the bedside. I still plan to follow her for a little while in acute care and discharge her when appropriate. I discussed my recommendations with nursing and ordered a regular diet.
2:50 pm – 7th FLOOR
This patient has Parkinson’s and was transferred to the hospital from skilled nursing with atypical chest pain. He is hard of hearing, and wearing an N95 mask makes it much harder to communicate at times. During the evaluation, he appears to show signs and symptoms of aspiration with thin liquids and will require an MBSS to confirm swallow integrity.
3:30 pm – CARDIAC DECISION UNIT
This patient came in with complaints of right upper and lower extremity weakness and slurred speech. MRI confirmed a left infarct. The patient presents with functional swallow, expressive language deficits, and apraxia. I ordered the patient a diet and completed the evaluation report/plan of care to address the observed deficits.
4:15 pm – FOLLOW UP
Remember that MBSS I had at 1:00, well I went back to visit her and let her know the results of the MBSS. I provided education and answered all relevant questions. This patient had additional complaints beyond my scope; I informed nursing, updated my progress note to reflect everything, and deferred to the appropriate discipline.
Some days are better than others, and this was not a difficult day. There are days when I have to provide counseling, I get asked about difficult decisions, I feel emotional, patients pass away, and the entire day falls apart. However, the days that I receive gratitude from families that I “started from the bottom with” or encouraged; patients finally go home, improve their communication, or get to order their favorite meal keep me going. I love how rewarding the field of Speech Pathology is.
4:45 pm – CLOCK OUT
We OUT! and chile, When I leave work, I love that I LEAVE WORK at work in acute care. Of course, I have to spend some evenings educating myself, but that’s the name of the game. Always continue to learn.
I hope this blog was helpful and provided some insight into the field of Speech Pathology from an acute care perspective. It is a brief snapshot and does not cover the day altogether, but please feel free to comment or reach out to me personally if you have any additional questions. I am always happy to help.
-Diamond
M.S., CCC-SLP
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