You're an SL- What?: Life as an Acute Care SLP

Hey hey, friends!! Up next in the "You're an SL- What?" Series is another of my favorite SLPs! (And I want to be her when I grow up! #fangirl)

Carmin Bartow is a rockstar in the SLP world and I am lucky enough to know her personally! I adore her on all levels! If you want to know more about her work, obviously read below, but you can catch her on the Swallow Your Pride Podcast as well! (I'm slightly obsessed with SYP!) 

I received my undergraduate and graduate degrees from Eastern Illinois University.  I have been a practicing SLP for over 20 years (which is what I'm saying from now on...a slightly vague "over 20 years") and am a Board Certified Specialist in Swallowing and Swallowing Disorders. The majority of my career has been spent evaluating and treating adult patients in medical settings such as home health, skilled nursing facilities, long-term acute care hospitals and acute care hospitals.  I have been employed a Vanderbilt University Medical Center for the past 15 years and I love my job! My areas of specialty are dysphagia, head and neck cancer, and communication and swallowing disorders related to tracheostomy and ventilator dependence. In addition to my clinical responsibilities, I facilitate a head and neck cancer support group and enjoy presenting and teaching at Vanderbilt as well as at state and national conferences.  In 2015, I authored an ASHA publication entitled “Management of Communication and Swallowing Impairments Related to Artificial Airways”.  I have been an adjunct instructor for Tennessee State University teaching Dysphagia both on-site as well as through the distance education program.  I frequently supervise Vanderbilt graduate students and enjoy introducing them to the world of acute care.  I have been an Educational Consultant for Passy Muir, Inc. for many years.  That opportunity has allowed me to travel throughout the US teaching SLPs, nurses, physicians and respiratory therapists about tracheostomy tubes and speaking valves.  Overall, it has been a very good “over 20 years”!

How did you learn about our field? Why did you become an SLP?

I was majoring in Elementary Education in college.  I did a classroom observation at the end of my freshman year and was seriously horrified!  I sat in the back of that classroom thinking there is no way I could do this. Yikes!  It was definitely time to rethink my career choice!  Fortunately, my mom was a guidance counselor at a community college and she encouraged me take a career assessment test.  Speech pathologist was listed in the top 5 professions I should consider.  I did a little researching and luckily the school I attended had a communication disorders and sciences major – so I went for it.  After attending a few classes and learning more about the profession, I knew it was a great fit me.  
Give a description of the setting and population you work with. How is this different from other settings/populations?
I work in a large teaching hospital.  Vanderbilt University Medical Center (VUMC) has approximately 800 beds, 8 ICUs and is a Level 1 Trauma Center.  I work with both inpatients and outpatients conducting FEES, VFSS and providing a variety of speech and swallow assessments and treatments throughout the hospital. One aspect that is different with a teaching hospital is the daily interaction I have with medical students, interns and residents.  It is a great environment to teach our future MDs about the important role of the SLP in acute care. 

Do you collaborate with other disciplines? 

Yes, I frequently collaborate with dieticians, nurses, respiratory therapists, nurse practitioners, OTs, and PTs.  That collaboration is one of the aspects of my job that I really enjoy.  I have learned so much from these other disciplines and I know that using a team approach to care can result in the best patient outcomes.
Another example of collaboration is the Vanderbilt Multidisciplinary Tracheostomy Consult Service.  This service did not exist for years and there were many inconsistencies in tracheostomy care including referrals to speech pathology. I worked hard with several people from various disciplines (nursing, ENT surgeon, Trauma MD, respiratory therapy) to implement a trach team at VUMC.  After a multi-year endeavor, our efforts finally came to fruition.  The VUMC Trach Team exists!  I am part of this team along with a nurse practitioner, nurse proceduralist and MD.  Our team has significantly improved and standardized tracheostomy care in our facility. (Be on the look out for our first publication in SIG 13 Perspectives this year).

What are common diagnoses that you see?

Our SLP team evaluates and treats patients throughout the hospital with a variety of speech / language / cognitive and swallowing disorders.  

My particular areas of interest are:
  • Iatrogenic dysphagia (such as post-extubation dysphagia, radiation associated dysphagia and dysphagia associated with tracheostomy)
  • Dysphagia due to primary diagnosis  (such as stroke, TBI, and neurodegenerative disease)
  • Head and neck cancer
  • Communication impairments associated with tracheostomy and ventilator dependency
  • I spend the majority of my day working in the intensive care units. 

What is the greatest challenge you face in your specific setting that may be different from other settings?

Too many patients. Too little time.  Each acute care SLP starts the day with a full caseload of patients.  However, new referrals are entered all day, in all units throughout the hospital. Some days it is difficult to keep up!  Although it is often super busy and intense, I definitely enjoy the fast paced, think-on-your-feet environment of acute care.  

What is the greatest reward for you in your job?

I’ll give a 2 part response…
The most rewarding thing I do in my daily patient intervention is restoring communication to patients with tracheostomy and ventilator dependence.  There is quite a bit of research about ICU patients with tracheostomy experiencing delirium, depression, frustration, loss of dignity, and poor quality of life.  I know that a significant contributing factor is the inability to effectively communicate. When I can restore communication for these patients I know I’m making a difference.  There are many days that I’m holding back tears (sometimes unsuccessfully) as patients and families talk to each other, sometimes for the first time in quite a while.

Another very rewarding experience is facilitating a head and neck cancer support group at Gilda's Club Middle Tennessee.  We are a local chapter of SPOHNC (Support for People with Oral and Head and Neck Cancer) and have approximately 40 members.  I have learned so much from this awesome, inspiring, and supportive group of people!   

If you could teach the world one thing about our field that most people don’t know, what would it be?

Hmmm….that is a hard one!  I’m not sure about teaching the world, but I’ll share something I’m doing to teach other SLPs about medical speech pathology. We all learn the importance of evidence-based practice, but it is difficult to stay current and well versed in everything related to medical speech pathology. And, it is very difficult to find a good medical speech pathology course!  So, 3 years ago my SLP colleagues and I decided to host our very first “Medical Speech Pathology: Best Practices” course.  Our focus is to discuss best practices in the diagnosis and treatment of communication and swallowing disorders for adults with a variety of diagnoses. Our conference focuses on practical approaches to managing these patients and emphasizes the importance of implementing evidence-based practice in daily evaluation and treatment. We have presented on a variety of topics relevant to the medical SLP such as head and neck cancer, trach / vent, dysphagia evaluation and treatment, movement disorders, TBI, palliative care, delirium, and aphasia. In addition, our physician colleagues from various areas such as radiology, medical oncology, neurology, ENT, and trauma have presented at our conference to share their expertise and to highlight the importance of collaboration between the physician and the speech-language pathologist.  We have received great feedback from attendees and are enthusiastic about our next conference in February, 2019!

Anything else you’d like to include about yourself, your job/setting, or anything SLP related.

I was asked to give a lecture on the topic of “lifelong learning” recently. I’ll admit that I had some eye rolling moments when thinking about how to prepare for that talk. What do I know about lifelong learning? But as I started preparing for it, I realized that lifelong learning has really been key for me.  Continuing to learn, grow, take on challenges and seek new opportunities is what has kept me passionate about my career. I know my professional life would have been much less satisfying and probably a bit boring if I remained stagnate.  So, for any CFYs or young clinicians reading this, I would encourage you to find your niche and seek opportunities to grow, develop new skills, take on challenges and to keep learning.

Thank you so much, Carmin! You are such an incredible asset to our field, role model for all of us SLP babies, and a wonderful woman overall! I count myself blessed to know you!

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