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The Role of Speech Pathology in the ICU: Impacting Patient Outcomes

presented by Jo Puntil, MS, CCC-SLP, BCS-S, F-ASHA

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Disclosure Statement:

Financial: Jo Puntil receives compensation from MedBridge for this course. She is also a full-time salary employee at St. George Regional Medical Center.

Non-Financial: Jo puntil is a past chair of the ASHA CFCC Council, and a DRS Program committee member (2020–2021). She is a Reviewer of Applications for Board Specialty in Swallowing/Swallowing Disorders, and a reviewer for AJSLP and DRS for possible publication. She is also a SIG 13 Member.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 79 Minutes, Learning Assessments: 44 Minutes

There is a strong need for integration and collaboration in the provision of Speech Pathology services in the ICU. Staffing, regulatory, and financial challenges in the hospital industry, have moved many healthcare workers from integrated team approaches of care into silos. A team approach is the best method to effectively integrate best practices with ICU trends and bundles. Speech Pathologists involvement in the ICU and their understanding of A-F bundles are paramount to initiate evaluations and treatment at the onset of illness to ensure patient-centered care.

This course will cover the prevalence and evidence of ICU trends and bundles, how patients benefit from communication and swallowing services, and how to deliver adult ICU evidence based patient-centered care. A summary will be provided on how Speech Pathologists assist patients with communication needs while intubated by utilizing nonverbal methods. Strategies for collaboration with RNs on managing post-extubation dysphagia and the need for implementing evidence-based swallow screens will be reviewed. This course will walk through the Speech Pathologists' role in educating patients and their families regarding post-intensive-care syndrome and how to pragmatically work through the patients' cognitive, emotional, and physical difficulties due to the harsh ICU environment. This course is applicable to any healthcare Speech Pathologist.

Meet Your Instructor


Jo Puntil is an ASHA Fellow, past chair of the CFCC, and a board-certified specialist in swallowing and swallowing disorders. She has extensive experience in developing interdisciplinary rehab programs/teams throughout southern California and Utah, specifically in the areas of critical and acute care. Jo has lectured nationally for more than 30 years. She has numerous…

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Chapters & Learning Objectives

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1. A–F Bundle, Part 1: Assessment of Pain, Breathing, and Choice of Sedation

The theory behind a care bundle is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcomes. Assessing pain, breathing, choice of analgesic, delirium, early mobility, and family participation is one such bundle that has improved patient outcomes across the globe. Assessing pain, spontaneous breathing trials/sedation vacation, and choice of analgesic is a crucial component to improve patient outcomes.

2. A–F Bundle, Part 2: Delirium, Early Mobility, and Family

The second half of the A–F bundle assesses delirium daily and addresses why it is important to understand the types of delirium. It is crucial to minimize the time an ICU patient spends in a delirious state. Early mobility and family participation in daily care of the patient help patients maintain awareness and attention to tasks while on sedation vacations. The more a patient moves and is engaged with family and medical staff, the less cognitive impairments are noted later in the hospital stay.

3. Intubation/Extubation: Swallow Screening and the Role of the SLP

Understanding the ramifications of intubation on the larynx related to swallowing is important for the speech pathologist to understand. Postextubation dysphagia is prevalent and needs to be addressed in all ICUs. The timing of an RN screen post extubation has been researched. Educating RN staff regarding their role in postextubation swallow screens and when the patient may need a bedside evaluation is a crucial step for patient recovery.

4. PICS: Prevalence and Consequence

Post-intensive-care syndrome is a collection of physical, emotional, and cognitive symptoms that persist after a patient leaves the ICU. Speech pathologists play an important role in evaluating and treating patients from the onset of their injury to reduce the ramifications of PICS. Education for patients and their family members should be ongoing throughout their hospital stay.

5. Interprofessional Collaboration: Cross-Communication

When multiple healthcare professionals work together to achieve patient-centered care, optimal outcomes are achieved. Communication in ICU rounds, both before and after patient care, is needed due to the medical fragility of these patients. Helping patients determine achievable goals guides them in a positive direction so they can transfer to the next level safely. Team collaboration daily is the key to success.

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