Referrals to speech pathology

1.7 Any person with suspected aphasia should be referred to a speech pathologist.

Reference: The Canadian Stroke Strategy, 2010: Clinical guidelines 
NHMRC Level of Evidence: GPP

Rationale: There is a paucity of information on the best procedure (e.g., blanket referral) for referring people with aphasia to speech pathology services. However, it has been suggested that the multidisciplinary team should assess stroke patients and formulate a management plan within 24-48 hours of admission (The Canadian Stroke Strategy, 2010). Organised systems and protocols are required to enable the rapid transfer of stroke patients from the emergency department to a stroke unit and referral to all multidisciplinary members of the team, including speech pathology.

Referrals to speech pathology

The literature and guideline recommendations with regards to referral processes for people with aphasia is limited. However, there are general management recommendations that can be applied to the aphasia population. The Canadian Stroke Strategy (2010) recommends that the interprofessional team should assess patients with stroke and formulate a management plan within 24-48 hours of admission. It is further recommended by the National Stroke Foundation (2010) that the multidisciplinary stroke team should meet regularly (at least weekly) to discuss assessment of new patients, review patient management and goals, and plan for discharge.

The Speech Pathology Australia (SPA) Position Paper on Dysphagia (2004) mandates that each facility should have a policy documenting from whom referrals can be accepted (i.e. hospital medical staff, general practitioners, nursing staff, allied health professionals, client/family/carers, blanket referral for neurology ward),  in which format (i.e. verbally or in written) and that each facility should determine the preferred method of referral and ensure all referring agents are aware of how to refer to the speech pathology service. Such protocols should also apply to the area of aphasia.

It is recognised that some people with aphasia post-stroke may not present to a hospital or be referred to the speech pathology service. It is therefore important that potential referring services (e.g. aged-care facilities, general practitioners, community-based health professionals) are aware of aphasia and how to refer to speech pathology services.

References:

1. The Canadian Stroke Strategy. (2010). Canadian Best Practice Recommendations for Stroke Care. Ottawa, Ontario Canada, Canadian Stroke Network.
2. National Stroke Foundation. (2010). Clinical guidelines of stroke management 2010,  Melbourne,  Australia
3. Speech Pathology Australia. (2004). Dysphagia: General Position Paper. 

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