Voice specialized speech language pathologist Edie Hapner, PhD CC-SLP shares how she and laryngologist Blake Simpson, MD are effective in serving UAB Voice Center patients through an interprofessional voice telemedicine clinic during the COVID-19 crisis.

Historically, patients require a laryngeal examination prior to any voice therapy being started; however, with COVID and the AGP status of laryngeal imaging, the team - and teams around the world - are relying on the speech language pathologist (SLP) with voice expertise to help triage the likely origin of the voice problem and any concerns of malignant vs. benign disease that would necessitate an immediate imaging, whether laryngeal or other, to rule out concerns.

This interprofessional telemedicine clinic mimics our flow in the face-to-face Voice Center, and here's what we've found to be most successful in providing care:

• At the start of the day huddle with the team electronically to review schedule, patient history, and any concerns noted in the history or referral.

•  As an SLP team member, I initiate the eMedicine visit and send the physician and patient an SMS in-vite to the appointment.

• The SLP starts the video visit, introduces who will be on the call, discusses history, and course of voice or upper airway problem.

• The physician joins the video visit about 5-10 minutes in (or I will text him that we are ready).

• The SLP team member summarizes history for the physician with patient listening and then confirms with patient that a comprehensive view of the history was given to the physician.

• The Physician and SLP engage the patient. This is fluid, as we discuss in our morning huddle who is likely to take the lead on the call which may be dictated by the generally suspected diagnosis and most likely treatment, medical/surgical or therapy.

• It is truly a 3-way conversation as there is much literature to support the use interprofessional care for people with voice disorders to improve adherence to treatment as well as overall outcomes.

• A decision on follow up care is determined, and a message is sent to our scheduling pool during the appointment regarding scheduling the patient. This is usually done by the SLP while the physician summarizes the visit to patient.

• Then the process repeats. The SLP sends the invites to the next visit and begins the next appointment while the physician generally completes documenting the previous visit and joins the new appointment 10-15 minutes in.