SALT Referral (Inpatient) 🗣️
Guide for inpatient speech and language therapy (SALT) referral. Key information for swallow and communication assessments, common indications, and referral scripts for NCHDs.
📋 Key Info to Have Ready
- Patient identifiers: name, DOB, MRN, ward and bed location
- Reason for referral, being specific: swallow assessment, communication assessment, voice, or both
- Current oral intake status: eating and drinking, modified diet/fluids, NG/PEG fed, or nil by mouth (NBM)
- Why swallow is a concern: coughing/choking with oral intake, wet voice, recurrent chest infections, drooling, residual food in mouth
- Neurological or ENT context: stroke, Parkinson’s, progressive neurological disease, head and neck cancer, post-extubation, recent ENT surgery
- Cognition and alertness: can the patient sit up and follow simple instructions for a bedside swallow screen?
- Respiratory status: oxygen requirement, recent aspiration pneumonia or chest infection
- Medications that matter: sedatives, anticholinergics, opioids; and whether tablets can be crushed or need liquid formulations
- Baseline swallow and communication, plus any known thickened fluids, soft diet, or speech aids at home
- Urgency and plan: e.g. awaiting safe swallow before oral meds/diet, or communication support for capacity/consent discussions
🔎 Common Reasons to Refer
- Suspected dysphagia: coughing, choking, wet voice, or difficulty managing saliva with oral intake
- Post-stroke or acute neurological change: swallow screen failed or high aspiration risk; keep NBM until assessed
- Recurrent or suspected aspiration pneumonia with swallow concerns
- Post-extubation or after prolonged intubation: swallow and voice review
- Head and neck pathology: cancer, surgery, radiotherapy, or ENT issues affecting swallow or speech
- Communication assessment: aphasia, dysarthria, cognitive-communication difficulties affecting ward care or discharge
- Advice on diet/fluid modification, strategies, or alternative feeding (NG/PEG) in liaison with the medical team and dietetics
- Voice changes with clinical concern (e.g. post-thyroidectomy, recurrent laryngeal nerve injury), per local pathway
📞 Example Referral
- Hi, this is [Your Name], the intern from [Team Name]. I'd like to refer a [Age]-year-old patient on [Ward] for speech and language therapy.
- They were admitted with [e.g. stroke / pneumonia / fall with reduced GCS] and we're referring for [swallow assessment / communication assessment].
- Currently they are [NBM / on soft diet / coughing with thin fluids]. Swallow concerns include [e.g. wet voice after sips, choking on tablets].
- They are [alert / drowsy], sit up [independently / with help], and cognition is [intact / impaired]. Chest status: [e.g. O2 2L, treated for aspiration pneumonia].
- Baseline was [normal diet and fluids / already on thickened fluids]. We need advice on [safe oral intake / meds route / communication for discharge planning].
- Many hospitals use an electronic or paper referral form rather than a phone call. Include the same details there, and phone SALT directly if urgent (e.g. acute stroke NBM, unsafe swallow with chest deterioration).
📝 Tips
- If aspiration risk is high or the ward swallow screen fails, keep the patient NBM (including oral meds) until SALT review, and arrange an alternative meds route
- Do not trial oral intake yourself beyond an approved local swallow screen; document the screen result and time
- Refer early after stroke and post-extubation; delayed swallow clearance blocks oral meds, nutrition, and discharge
- Say whether the priority is swallow, communication, or both; vague “SALT review” referrals get deprioritised
- Sit the patient upright and suction oral secretions if needed before assessment; flag if they are too drowsy to participate
- Involve dietetics for nutrition when NBM or on modified diet; SALT advises safety of swallow, not calorie targets alone
- Weekend and out-of-hours SALT cover is often limited; escalate medically if the chest is deteriorating and swallow remains unsafe
- For complex discharges, raise at MDT so SALT, dietetics, physio, OT, and the discharge coordinator share one plan