Table 2.
Prioritization results
| Workforce Planning, Preparation, and Management | Total Rank Score | Rank |
|---|---|---|
| Identify staff with ICU-specific clinical skills in relation to communication, swallow, and tracheostomy patient management. | 369 | 1 |
| Transparent, clear, and timely communication of COVID-19 infection information relating to ICU care. | 334 | 2 |
| Review of current caseload service delivery to identify capacity for increased service provision to higher acuity and increased clinical demand. | 304 | 3 |
| Transparent, clear, and timely communication of COVID-19 infection information from federal authorities for training in COVID-19 appropriate PPE. | 304 | 3 |
| Educate staff to minimize environmental cross contamination with equipment. | 284 | 5 |
| Facilitate clinical education for ICU-specific clinical skills in relation to communication, swallow, and tracheostomy patient management. | 282 | 6 |
| Educate staff for the developments of COVID-19-specific disease progression (eg, delayed onset of new laryngeal symptoms, PICS). | 256 | 7 |
| Monitor staff mental well-being. | 213 | 8 |
| Consider provision of rehabilitation services for post-ICU discharge, including access for ongoing swallow and communication therapies. | 190 | 9 |
| Staff access to uniforms (eg, scrubs) for provision of care in ICU. | 187 | 10 |
| Educate staff of reporting guidelines for clinical incidents related to COVID-19. | 180 | 11 |
| Consider additional resources (including training) for the acquisition of telehealth capabilities. | 143 | 12 |
| Consider staff training needs for provision of rehabilitation services post-ICU discharge (ie, PICS) | 139 | 13 |
| Management of Communication Function | Total Rank Score | Rank |
|---|---|---|
| Access to resources (eg, glasses, hearing aids, call bells, AAC) to enable increased patient communication. | 247 | 1 |
| Make accessible a range of communication options to address diverse communication profiles, including alternative and augmentative communication systems and strategies, to non-SLP staff (eg, nurses, physicians). | 220 | 2 |
| Patients should be provided with support for engaging with family and support networks using communication aids and technologies. | 209 | 3 |
| First consider nonaerosol generating communication supports and aids. | 195 | 4 |
| Consider interpreting services (via phone or electronics) to enhance communication (to include culturally and linguistically diverse backgrounds). | 172 | 5 |
| Cuff deflation is an AGP. Communication procedures for patients with a tracheostomy that require cuff deflation (eg, speaking valves, leak speech) during mechanical ventilation should be discussed with the treating ICU team. | 159 | 6 |
| Cuff deflation is an AGP. Communication procedures for patients with a tracheostomy that require cuff deflation (eg, speaking valves, leak speech) without mechanical ventilation should be discussed with the treating ICU team. | 147 | 7 |
| Above cuff phonation is an AGP. Management and use should be discussed with the treating ICU team. | 129 | 8 |
| Communication procedures for patients with a stoma (ie, laryngectomy including voice prostheses) should be discussed with the treating ICU team. | 97 | 9 |
| Management of Swallowing Function | Total Rank Score | Rank |
|---|---|---|
| Staff should meet regularly with ICU staff (ie, physicians, nurses) to determine indications for swallowing management in patients with (or suspected) COVID-19. | 322 | 1 |
| Cuff deflation is an AGP. Swallowing procedures for patients with a tracheostomy that require cuff deflation (eg, speaking valves) during mechanical ventilation should be discussed with the treating ICU team. | 240 | 2 |
| Cuff deflation is an AGP. Swallowing procedures for patients with a tracheostomy that require cuff deflation (eg, speaking valves) without mechanical ventilation should be discussed with the treating ICU team. | 231 | 3 |
| Flexible endoscopic evaluation of swallowing is considered an AGP. Assessment should be discussed with the treating ICU team. | 227 | 4 |
| Patients should be supported to independently complete aspects of swallow rehabilitation as able. | 217 | 5 |
| Noninvasive ventilation (eg, high-flow nasal oxygen, BiPAP) is considered an AGP. A swallowing assessment in this context should be discussed with the treating ICU team. | 210 | 6 |
| Patients should be encouraged to self-feed where able. | 210 | 6 |
| Swallowing therapy tasks that are not aerosol generating tasks should be provided to patients. | 208 | 8 |
| VFSS may be considered an AGP. Assessment should be discussed with the treating ICU team. | 183 | 9 |
| Cleaning noninvasive equipment (eg, stethoscopes, flashlights, ultrasound) between patients should be discussed with the ICU staff due to risk of cross contamination and health care worker infection. | 167 | 10 |
| Respiratory muscle strength training (ie, EMST and IMST) is considered an AGP. Implementation should be discussed with the treating ICU team. | 95 | 11 |
Abbreviations: AAC, augmentative and alternative communication; BiPAP, bilevel positive airway pressure; PICS, postintensive care syndrome; PPE, personal protective equipment; EMST, expiratory muscle strength training; IMST, inspiratory muscle strength training.