Aim This audit provided an opportunity to evaluate the referral process to speech and language therapy (SALT) as part of the Health Foundation (HF) safer clinical systems project. The project focused on inpatient management of children in a large tertiary children’s hospital with particular attention being paid to medically complex children.

Methods Our study consisted of two audits of children referred to SALT, the first between January and May 2012 and the second between November 2012 and March 2013. Both samples consisted of children which met the criteria of medically complex as set by the HF. Upon agreeing audit standards, data was collected from the patient notes and analysed appropriately.

Results The first audit revealed 55% of referrals to SALT were received on the day of referral, 41% took up to 5 working days with the remaining 4% taking longer. Based on these results, referrals were made electronic which increased same day referrals to 82.1% as demonstrated in the second audit, with the remaining referrals being made within two working days.

The first audit found 23% of dysphagia referrals were seen within a two working day standard. Trial employment of an extra therapist increased this number to 96%, which dropped to 67% post trial. An extra therapist enabled a correctly banded clinician to review an appropriate child up to 91.3% of the time, this reduced to 64% post trial.

The HF project aims to reduce length of inpatient stay. The first audit revealed a time lag between referral to SALT being suggested in the medical notes to SALT receiving the referral. This represented an extra 3.23 days in hospital per child. This reduced to an extra 1.52 days in hospital when referrals to SALT were sent electronically.

Conclusion The outcome of this audit demonstrated how to improve inpatient referrals to SALT and aided the SALT team in providing more timely assessment of medically complex children. It demonstrated the need for more resource and that an extra therapist enabled clinicians with the correct skill mix review the appropriate child. It was found electronic referrals to SALT impact positively on inpatient stay.