Prioritisation Systems Used in Adult Speech and Language Therapy Settings: A Scoping Review

Prioritisation is an important and necessary practice in speech and language therapy (SLT) departments, as the increasing demand for services often exceeds available resources. Despite being a key clinical activity within the profession, however, there is limited research on evidence-based methods for prioritisation systems (PS) used in adult SLT settings. As a result, the absence of standardised guidelines poses a risk of inconsistency in current prioritisation practices. This may lead to an unequal distribution of resources, potentially affecting patient well-being and outcomes.

A scoping review was carried out which aimed to identify the PS used in adult SLT settings and to determine the facilitators and barriers to the development and implementation of effective PS in these settings. This study was conducted in line with PRISMA-ScR guidelines, with a protocol prospectively published (https://osf.io/dbtsf/). Six academic databases, three professional body websites, and two national health service websites were searched using a multi-tiered search strategy with assistance from a subject expert librarian. Data was charted regarding outcomes of interest, and critical appraisal using study design-specific tools was completed by two independent researchers.

Of the 10 studies eligible for inclusion, 60% identified dysphagia as a high priority for earliest intervention, with 30% consistently prioritising dysphagia over any communication deficits due to the medical implications of unmanaged swallowing problems. The majority did not address facilitators (60%) or barriers (80%) to developing or implementing PS. The absence of a standardised prioritisation system was noted throughout the included studies, with clinical judgement alone, non-standardised systems, or chronological order of referral commonly used in prioritisation.

This scoping review examines the limited existing literature on PS in adult SLT settings, noting the lack of evidence-based or standardised systems. Further research is now needed to identify the critical factors which influence a clinician's prioritisation process prior to ultimately conducting subsequent research into the facilitators and barriers to developing and implementing evidence-based PS in order to establish best practices to improve patient care, experiences, and outcomes.

What is already known on this subject Caseload prioritisation decisions are often made by individual speech and language therapists (SLTs) (Foster et al. 2014), and this can compromise the fair distribution of the allocation of resources. A lack of reliability and subjectivity are barriers to the use of prioritisation systems (PS) in healthcare settings (McRae et al. 2021). Subjectivity in prioritisation decisions impacts consistency across different settings, as therapists in different settings may have different interpretations of the criteria for various priority levels (Rice 1998). What this paper adds to existing knowledge Prioritisation practices in speech and language therapy services vary, and to date, a systematic search of the published literature on PS in adult speech and language therapy settings has not been published. This study provides a comprehensive overview of the literature on PS used in adult speech and language therapy settings. What are the potential or actual clinical implications of this work? A core finding of this review was the lack of available information regarding the specific details of PS used in practice or facilitators and barriers to the development and implementation of effective SLT PS within real-life clinical settings. The lack of available explicit information hinders development in the field of SLT, as settings cannot learn from the experience of others and share knowledge regarding the profiling and overcoming of barriers, thus reducing opportunities for growth and ingraining unstandardised practices. There is a demand for development in this area, thus further highlighting the research gap and subsequent real-life clinical implications.