Inpatient Augmentative Communication Program

Research supports the notion that access to AAC enhances patient care and is closely linked to patient satisfaction and safety (Happ, 2004; Patak et al. 2006). Patients admitted to the ICU are already at high risk for communication vulnerabilities based on admitting criteria, and therefore adequate communication with providers and loved ones is key to ensuring patient safety and prevention of adverse events. Pediatric patients may also experience a loss of control, sense of self, and ability to participate in their own care (Garrett et al., 2007), which can in turn result in feelings of insecurity, panic, worry, fear, and anger (Happ et al., 2004) when unable to effectively communicate. The opportunity to reduce communication breakdowns by preparing materials and strategies prior to the onset of a communication vulnerability can potentially prevent these negative factors.

Benefits of early preparation:

• The hospital admission may be stressful to pediatric patients and their families. Establishing communication methods ahead of time may reduce later stress and worry.
• Postoperatively, many patients can experience misunderstanding, confusion, and waxing and waning mental statuses due to effects of medication.
• Early participation in the selection of communication tools and vocabulary can be completed during a less acute and stressful time.
• If able, patients can digitally record their own voice into a communication system using natural inflection, meaning, and intonation.
• Time to familiarize with previously selected communication materials may lead to easier and more functional use.
• Patients often experience a sense of control in their own care and preservation of their personality.

A wide variety of patients are seen preoperatively in anticipation of many different medical or surgical procedures and interventions. These patients may include those who have or will be undergoing the following:

• Baseline speech, language, and communication deficits
• Any form of invasive ventilation
• Tracheostomy
• Non-invasive ventilation (BiPap, CPap)
• Oro-facial surgery
• Brain tumor resection or biopsy
• Other neuro-surgical procedures
• Complex dental procedures
• Baseline motor impairment
• Anticipated motor impairment
• Degenerative neurological or neuromuscular disease
• Other

At Boston Children’s Hospital, a speech-language pathologist in the Inpatient Augmentative Communication Program is on call weekdays at our main campus location and can be reached to provide face-to-face consultation with patients in the context of their preoperative appointments. If you are unable to meet with an SLP during your visit, phone and email correspondence is recommended to connect prior to your child’s upcoming hospital stay. Have your provider call the inpatient SLP to arrange a preoperative consult.