We all know how prevalent swallowing disorders are, especially in our elderly population. We know how dysphagia can cause pulmonary complications and even systemic disease that can increase patient mortality.
So why not do things differently, to change outcomes, improve patients’ quality of life, and reduce costs associated with hospitalizations?
What can we do differently??
If patients are admitted from the hospital on modified diets –> do an instrumental assessment after a reasonable period to allow for recovery (5-10 days depending on a number of factors). Patients do recover from their acute deficits and may no longer need thickened liquids.
This saves the facility money $$$ and drives satisfaction scores up!
If patients are on thickened liquids and show signs of aspiration (cough, wet vocal quality, persistent throat clearing, etc.) –> do a follow up instrumental ASAP. Thickening liquids even more (such as downgrading from nectar to honey) is not a smart solution. There is a higher incidence of silent aspiration with thickened liquids. In fact, the thicker the liquids, the more likely the patient with dysphagia will aspirate silently. Plus, there is mounting evidence that aspiration of thickened fluids is MORE detrimental to the lungs.
Bottom line, thickening liquids based on clinical exams, could increase your patients chances to get a lung infection. It could also result in dehydration and all the cascade of problems that come with it.
Another scenario where the right test saves you money$$
Prioritize oral care–> Adequate oral hygiene doesn’t happen in many hospitals and long-term care facilities for many reasons. For our patients with dysphagia, this is a likely contributor to aspiration pneumonia. If they aspirate food/liquids, they are likely aspirating their secretions. Think about how many residents who are PEG dependent or consuming “the safest diet” end up with pneumonia. While the development of aspiration pneumonia is multifactorial, if oral hygiene is not properly maintained, the risk to develop aspiration pneumonia is much higher.
A small investment in oral care supplies and staff training, can reduce resident morbidity and mortality and save the facility money $$
Help the speech therapist help your residents –> Trust me, we, SLPs would love to take the credit. But the truth is, we cannot determine how to help our patients without an instrumental exam revealing what is wrong with the patient’s swallow.
Accurate diagnosis via instrumental assessment (video swallow study or FEES) leads to effective treatment plans. Otherwise, we are treating blindly, and that is, well, unethical. Plus, it could potentially be detrimental to the patients: we just don’t know. Investing a few hundred dollars in FEES for instance, can make a huge difference in functional outcomes, increase patient satisfaction, and maybe reduce the number of patients on modified diets. Yes, that can also save the facility money $$
Use real food items during swallow studies –> I can’t tell you how many times I get consults for a patient who choked on corn or rice, or bread. Or the patient will only eat certain items that are not included on the prescribed diet. While we can’t test every possible food item the patient eats, there is a way to use real food instead of a barium contrast during instrumental exams. Have you heard about FEES? FEES is a dynamic endoscopic exam, completed at the bedside or dining room, that allows evaluation with real food items, without the time constraints of an Xray exam. Is there a specific soup the family wants to bring, and you are not sure if it’s safe for the patient? Let’s try it too. As an added benefit, FEES is more cost effective than video swallow tests. Just a little extra saving$$ while keeping our patients safe. And FEES also provides all information your SLP need for her plan of care.
How can WE help?
- We can help you establish an oral hygiene program and provide staff training on adequate oral care protocols.
- We can provide Flexible Endoscopic Swallow Evaluations (FEES) at your facility in a timely manner.
- We can collaborate with your Speech Therapist during swallow studies, to ensure all concerns are addressed and we correlate clinical presentation with exam findings. Visual feedback can be provided for staff and caregiver education, as well as patient training on strategies identified as helpful during FEES.
- We serve as expert consultants regarding dysphagia management.
- We welcome patients to try their preferred foods. After all safe and efficient swallowing are just as important as good nutrition.
- We can address any family questions and concerns based on results from our FEES exams.
Can you think of something else??
Just email us at: firstname.lastname@example.org