Proposed Facilities Norms and Standards for ST&A departments

No need for particular specialised Speech Therapy facilities were identified for a specific level of care, so the below activity was done only for Audiology services.

Audiology services determining the need for specialised facilities at different levels of care

Activity / Levels of care/service delivery
Community / PHC / District hosp / Regional hosp / 2°/3°/ Academic / TB
Behavioural screening / x / x / x / x / x / x
Infant screening / x / x / x / x / x
Cerumen management / x / x / x / x / x / x
Diagnostic behavioural testing / x / x / x / x
Visual Reinforcement Audiometry / x / x / x / x
HA fittings and evaluations / Dep on equip & staff / x / x / x / x
HA verifications / x / x / x / x
Diagnostic electrophysiology testing / x / x / Diagnostic OAE
Vestibular assessment and intervention / basic / basic / x / basic
Counselling / x / x / x / x / x / x
Tinnitus management / x / x / x / x / x / x
Earmould-linked activities / x / x / x / x / x / x
Aural rehab / x / x / x / x / x / x
Student training / Bigger hospitals / x / x / x

Colour of ‘x’ indicates type of room to be used for the activity; see descriptions below

Room types for Audio activities

Diagnostic Audiology and VRA room

  • Free-standing soundproof, wheelchair-accessible 2.5m x 2.5m booth with 0.5m space around all sides and roof.
  • Booth and room must have extractor fan to outside (for TB infection control).
  • Room must be sound-treated for live voice testing (Must comply with SANS 10182).
  • Clean power supply with Uninterrupted Power Supply and surge arrestors to protect Audiology equipment.
  • 4 plugpoints with plugpoint covers.
  • Dimmable lighting.
  • Space for table and chair for audiometer in front of window of booth,desk for tymp machine and three chairs.
  • Lockable storage cupboard and filing cabinet.
  • Will be used for testing, as well as post-test counselling of patients.

Diagnostic electrophysiology testing room

  • Extractor fan to outside the room.
  • Room must be sound-treated for live voice testing (we need to specify maximum permissible dB level from outside noise).
  • Clean power supplywith Uninterrupted Power Supply and surge arrestors to protect Audiology equipment.
  • 3plugpoints with plugpoint covers.
  • Dimmable lighting.
  • Suction and oxygen supply, monitoring equipment (heartrate, BP, SPO2).
  • Reclining examination bed, cot, opaque blinds, two chairs and desk near double plugpoint with plugpoint cover for impedance meter and OAE.
  • Lockable storage cupboard and filing cabinet.
  • Chair with wheels for Audiologist.
  • Reclining chair for adult patients (Lazy-Boy type)
  • Basin with hot and cold water.

Vestibular room

  • Minimum of 3m x 4m room with no carpets.
  • Reclining examination couch, three plugpoints with plugpoint covers, basin.
  • Desk, two chairs and chair with wheels for the Audiologist.
  • Rotary chair for the patient.
  • Lockable storage cupboard.

Treatment room

  • Standard specification approximately 14m2with basin, plugpoint with plugpoint cover, washable floor.
  • Table, three chairs, Lockable storage cupboards.

Consulting room

  • Standard specification approximately 14m2with carpet, basin, plugpoint with plugpoint cover, desk and three chairs.
  • Must be quietly situated.

Room for HA services in secondary/tertiary/academic setting

  • Consulting room with sofas, table for HA equipment.

Office

  • Office 6m2 per person: shared between three therapists, with 1 network point and plugpoint with plugpoint cover per desk and an extra double plugpoint with plugpoint cover (for heater, vacuum-cleaner, etc) and space for an additional two chairs.
  • Single office for Assistant Director, with 1 network point and plugpoint with plugpoint cover and an extra double plugpoint with plugpoint cover (for heater, vacuum-cleaner, etc), with space for a desk and 3 chairs.

Room types for Speech Therapy activities

Observation complex

A three-room observation complex consisting of the following:

  • A central 3m X 5m room with chairs for observers.
  • A 5m x 5m room, carpeted, with a plugpoint with plugpoint cover, intercom system, 1-way mirror with curtains or shutters between it and the adjoining room, temperature control and dimmable lights.
  • A 4m x 5m room, with a washable floor, basin, plugpoint with plugpoint cover, intercom system, 1-way mirror with curtains or shutters between it and the adjoining room and dimmable lights.
  • It is envisaged that in smaller institutions this complex would be shared with other professions, e.g. OT, Psychology, MOP outreach, etc.
  • This complex would be used for observation of caregiver-child interactions, group therapy including multi-disciplinary groups/clinics, observation by students and group training sessions.
  • The complex should be situated near the waiting area, to allow for easy access by patients coming for multidisciplinary clinics.

Consulting room

  • Standard specification with carpet, basin, plugpoint with plugpoint cover, desk and four chairs.
  • Must be quietly situated.

Office

  • Office: shared between three therapists, with 1 network point and plugpoint with plugpoint cover per desk and an extra double plugpoint with plugpoint cover (for heater, vacuum-cleaner, etc). Chief therapist(s) should also have a separate office, shared by no more than three Chief therapists per office.
  • Single office for Assistant Director, with 1 network point and plugpoint with plugpoint cover and an extra double plugpoint with plugpoint cover (for heater, vacuum-cleaner, etc).

Note regarding TB Hospitals

  • To prevent cross-infection of patients, it would be preferable to have separate Audiology testing facilities for MDR and XDR areas/wards/patients.

Generic and shared spaces

  • Office for Deputy Director: Rehabilitation in Admin block
  • Waiting area with chairs, table for information, complaints box, 1.5m x 2m pinboard.
  • Reception area with double plugpoint with plugpoint cover and network point per receptionist. Fax/photocopier must be sound-shielded from receptionist and must not be accessible to children in the waiting room.
  • Staff room for meetings, training, etc; size will depend on staff complement, but should accommodate at least 50% of Rehab staff on chairs around a central table.
  • Staff kitchenette with sink, kettle, mini-oven, fridge and microwave near the staff room
  • Lockable storeroom with shelves.
  • Lockable file storage room for patient records.
  • Disability-friendly bathroom with plinth for changing nappies on children and disabled adults.
  • Staff ablutions with toilets and basin(s) and separate ablutions for patients.
  • Student office for 3-6 students; size will depend on facility; only necessary in secondary/tertiary/academic hospitals.
  • Dormitory-style accommodation for caregivers needing training in the care of a permanently disabled person, or for block therapy; no nursing care or other staffing needed.
  • 4x4 vehicle fitted with all-terrain tyres modified for Rehabilitation outreach: with inverter for electrical supply to double plugpoint with plugpoint cover for audiology equipment, lockable storage cupboards, seating space for private consultation and awning for waiting patients. The number and availability of these vehicles would depend on the number of outreach venues and the surrounding terrain.

Location of Speech Therapy and Audiology departments

  • Speech Therapy and Audiology departments must be part of an Allied Health or Rehabilitation complex:
  • OT
  • PT
  • Human Nutrition
  • Medical Social Work
  • Psychologist
  • Radiography. Radiology must make provision for MBS/VFSS (modified barium swallow/videofluoroscopic study of swallowing) for dysphagia - hencemust have videorecordingand storage capacity. Facilities should begin to make equipment available for FEES (fibre-endoscopic examination of swallowing).
  • (Podiatrist)
  • (Biokineticist)
  • Audiology department must be in a quiet area as close as possible to ENT.
  • Rehab must be near:
  • Public transport drop-off point/parking area
  • Pharmacy
  • Radiography, if not part of Allied Health/Radiography complex
  • Wards
  • Paediatric OPD
  • Anaesthetists or Paediatric OPD for administration and monitoring of sedation for paediatric patients undergoing electrophysiological Audiology assessments.

Minimum profession-specific areas per profession at different levels of healthcare

Type of room / PHC / District hospital / Regional hospital / 2°/3°/ academic hospital / TB hospital
Diagnostic Audiology and VRA / 1 / 1 per 8 patients to be tested per day / 1 per 8 patients to be tested per day / 1 per 8 patients to be tested per day
Diagnostic electrophysiology / 1 / 1 / Diagnostic OAE
Vestibular room / 1 / 1 / 1 / 1
Observation complex / 1 shared with other Rehab in small hospitals / 1 / 1 to 2
Treatment room / 1 shared / 1 shared with other Rehab / 1 / 1 / 1
Consultation room / 1, reserved for visiting professionals; shared / 1 / 1 per three therapists per profession / 1 per three therapists per profession / 1
Office / 1 per three therapists / 1 per three therapists / 1 per three therapists + 1 for AD / 1 per three therapists
Student office / 1, possibly shared / 1, possibly shared / 1, possibly shared / 1, possibly shared
4x4 Rehab vehicle with all-terrain tyres / 1 per 5 outreach sites requiring 4x4 to access, otherwise 1 non-4x4 per 5 outreach sites / 1 per 5 outreach sites requiring 4x4 to access, otherwise 1 non-4x4 per 5 outreach sites / 1 per 5 outreach sites requiring 4x4 to access, otherwise 1 non 4x4 per 5 outreach sites

Possible staffing norm

Audiology

  • 1 Audiologist per booth
  • + 1 additional Audiologist at regional, secondary, tertiary and academic level hospitals.
  • + 1 Audiologist per specialised function (electrophysiology, vestibular).
  • + 1 Audiologist per 5 outreach sites.
  • + 1 Chief Audiologist per 3 Audiologists.
  • + 1 Assistant Director Audiologist at secondary/tertiary/academic hospitals.

Speech Therapy

  • 1 Speech Therapist per 30 adult beds, excluding Orthopaedic and Maternity wards.
  • + 1 Speech Therapist per 20 paediatric beds.
  • + 1 Speech Therapist per 5 outreach sites.
  • + 1 Chief Speech Therapist per 3 Speech Therapists
  • + 1 Assistant Director Speech Therapist at secondary/tertiary/academic hospitals.
  • 1 Deputy Director: Rehabilitation
  • 1 Speech Therapist per District Team on the Re-engineered PHC plan

No provision is made for ST&A MLW’s due to lack of clarity regarding their current status, future existence and training.

Possible determination of the number of Audiology booths and Audiologists needed: assuming that 5% of the population experiences some kind of hearing loss and they need to be diagnosed/retested/screened every three years, then theoretically 1.67% of the population served by a particular hospital would need behavioural diagnostic audiology per year. This number can be divided by 200 (approximate number of working days per year) to determine the average daily demand for Audiology services. This number can be increased by up to 50% for referral hospitals with ENT services, as well as hospitals performing OHS hearing assessments, as they would have additional patients referred.