Successful Collaboration on Breathing and Swallowing SLPs and respiratory therapists work together to help patients with conditions such as pneumonia and tracheostomies. On the Pulse
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On the Pulse  |   January 01, 2016
Successful Collaboration on Breathing and Swallowing
Author Notes
  • Nancy B. Swigert, MA, CCC-SLP, BCS-S, is director of speech-language pathology and respiratory care at Baptist Health Lexington in Kentucky and an adjunct faculty member at the University of Kentucky and Nova Southeastern University. A past chair of ASHA’s Health Care Economics Committee and immediate past chair of the American Board of Swallowing and Swallowing Disorders, she is an affiliate of ASHA Special Interest Group 13, Swallowing, Swallowing Disorders and Dysphagia. nancyswigert1066@gmail.com
    Nancy B. Swigert, MA, CCC-SLP, BCS-S, is director of speech-language pathology and respiratory care at Baptist Health Lexington in Kentucky and an adjunct faculty member at the University of Kentucky and Nova Southeastern University. A past chair of ASHA’s Health Care Economics Committee and immediate past chair of the American Board of Swallowing and Swallowing Disorders, she is an affiliate of ASHA Special Interest Group 13, Swallowing, Swallowing Disorders and Dysphagia. nancyswigert1066@gmail.com×
Article Information
Swallowing, Dysphagia & Feeding Disorders / On the Pulse
On the Pulse   |   January 01, 2016
Successful Collaboration on Breathing and Swallowing
The ASHA Leader, January 2016, Vol. 21, 34-35. doi:10.1044/leader.OTP.21012016.34
The ASHA Leader, January 2016, Vol. 21, 34-35. doi:10.1044/leader.OTP.21012016.34
“Got a minute to talk about the patient in room … ?” “Are you seeing the patient in room … ?”
These kinds of questions are often the start of collaboration between the respiratory therapist (RT) and the speech-language pathologist. Sometimes it’s the RT approaching the SLP after noticing the patient coughing during meals. Other times it’s the SLP initiating the discussion after seeing a patient work harder to breathe during a treatment session.
Collaboration between these two disciplines is a natural fit. Both have a comprehensive understanding of the upper aerodigestive tract, and each discipline also brings unique knowledge to the partnership. The RT, for example, has cardiopulmonary expertise, while the SLP has neurological expertise.
RTs and SLPs often work on interprofessional teams. Two disciplines that work closely together may encounter some overlap in responsibility and may disagree about whose job it is to perform a particular task. Successful interdisciplinary relationships handle these situations well, with each member of the team recognizing and respecting the clear role of each profession.
Scope of services
RTs are part of the health care team in every setting in which SLPs also provide treatment: acute care, long-term acute care, inpatient rehabilitation, skilled nursing, home health and some outpatient settings. Their coursework includes anatomy and physiology, cardiopulmonary diagnostics, medical gases and many other courses related to critical care.
Just as many consumers don’t understand the breadth of services that SLPs provide, many may think of the RT as only providing “breathing treatments” or managing the patient’s oxygen. RTs manage patients on ventilators and on noninvasive ventilation (continuous positive airway pressure or bilevel positive airway pressure) and administer a variety of diagnostic tests, including arterial blood gases, pulmonary function tests to assess lung volumes and rates of flow, and indirect calorimetry to measure resting metabolism. These diagnostic tests help guide the patient’s care.

Just as many consumers don’t understand the breadth of services that SLPs provide, many may think of the respiratory therapist as only providing “breathing treatments” or managing the patient’s oxygen.

RTs also specialize—in intubation or sleep medicine, for example—or participate on highly skilled teams, such as surface and air transport teams for critically ill infants, children and adults or neonatal delivery room teams, attending high-risk deliveries to be ready to resuscitate the neonate.
Others work in pulmonary rehabilitation, helping patients with chronic lung diseases cope with their conditions through education, treatment and exercise.
Working together
Interdisciplinary team members share knowledge—with the goal of achieving better patient outcomes—and communicate clearly, display mutual respect and know how to resolve conflicts. If each discipline keeps the focus on best patient outcomes, while adhering to the discipline’s scope of practice, such disagreements often can be resolved.
For example, RTs and SLPs may overlap in tracheal suctioning. The ASHA Scope of Practice is written broadly and does not mention specific activities such as suctioning. The task is most often performed by RT or nursing. In some circumstances, it may be appropriate for SLPs to be trained to provide suctioning, and often the RT provides such training.
Opportunities for collaboration between RTs and SLPs are plentiful. In addition to serving together on multidisciplinary teams—discharge and readmission, for example—and participating in multidisciplinary intensive care rounds, one-to-one collaboration can be helpful for patients with several diagnoses or conditions.

Interdisciplinary team members share knowledge—with the goal of achieving better patient outcomes—and communicate clearly, display mutual respect and know how to resolve conflicts.

Pneumonia. Some pneumonia presumed to be community-acquired may actually be aspiration pneumonia. If the SLP familiarizes the RT—who participates in pneumonia treatment—with clinical signs of dysphagia, the RT can facilitate referral to the SLP for a swallowing evaluation if the patient shows these signs.
Chronic obstructive pulmonary disease (COPD). The RT treats the patient and provides some the patient with disease management education. A 2014 study by Balwinder Singh and colleagues in JAMA Neurology found that older adults diagnosed with COPD may be at a higher risk for mild cognitive impairment—and SLPs have the knowledge and skills to assess cognitive deficits and know strategies to help affected patients learn new information. The SLP can team with the RT to explain the information to the patient in the most effective way.
Tracheostomies. The RT provides inhalation treatments, with the SLP working to help the patient to communicate with a speaking valve. Together, they facilitate adequate ventilation (if the patient is on the ventilator) or oxygenation and establish a route for verbal communication.
Noninvasive ventilation. The SLP may need to assess the swallowing of a patient on noninvasive ventilation that requires the patient to wear a mask. The SLP can consult with the RT to determine if it is safe for the patient to be off ventilation long enough for an evaluation and to eat meals if the patient can swallow effectively.
Paradoxical vocal fold motion (PVFM). Patients with PVFM are often misdiagnosed as having asthma. If the SLP shares information with the RT about the clinical signs and symptoms of PVFM, the RT may help identify patients who need an SLP’s evaluation and possible treatment. In addition, patients with PVFM have a characteristic profile on a pulmonary function test of flow volume: a normal expiratory loop and a flattened inspiratory loop.
As experts in the aerodigestive tract, RTs and SLPs have many opportunities for collaboration. When they approach collaboration with mutual respect and focus on shared goals and values, they can help patients achieve better outcomes.
Sources
Singh, B., Mielke, M. M., Parsaik, A. K., Cha, R. H., Roberts, R. O., Scanlon, P. D. & Petersen, R. C. (2014). A prospective study of chronic obstructive pulmonary disease and the risk for mild cognitive impairment. JAMA Neurology, 71(5), 581–588. doi:10.1001/jamaneurol.2014.94. https://www.nbrc.org/Pages/default.aspx [Article] [PubMed]
Singh, B., Mielke, M. M., Parsaik, A. K., Cha, R. H., Roberts, R. O., Scanlon, P. D. & Petersen, R. C. (2014). A prospective study of chronic obstructive pulmonary disease and the risk for mild cognitive impairment. JAMA Neurology, 71(5), 581–588. doi:10.1001/jamaneurol.2014.94. https://www.nbrc.org/Pages/default.aspx [Article] [PubMed]×
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January 2016
Volume 21, Issue 1