Experiences in implementing a Speech Pathology-led FEES service to improve patient access to instrumental swallow assessment: a quality improvement project.
Vanessa Van Der Groen1 1St John Of God Health Care, Midland, Western Australia, Australia
Abstract
Dysphagia impact 66% of people over 60, living in the community. Videofluoroscopy (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES) are the gold standards for evaluating dysphagia. FEES is less restrictive and safer than VFSS, as there is no exposure to radiation, nor possible aspiration of contrast, the procedure is performed at the bedside, and allows visualisation of secretion management and surface anatomy.
The aim of this project was to implement a Speech Pathologist-led FEES service, to increase access to assessment and reduce time required for referral and reporting. Implementation involved stakeholder meetings and approval and recognition of Advanced Scope of Practice, before a 3 month trial, followed by rollout to all adult inpatients and later, outpatients. Evaluation of the service is completed regularly and includes monitoring of adverse events, referral and reporting processes, which are reported to stakeholders.
In three years, there have been 172 speech-led inpatient FEES (131 VFSS in the same period), that have reduced wait times for instrumental assessment from 14 months to 7 days, and report times from 5 days (VFSS) to 2.6 days. FEES has facilitated earlier discharge for 77% of dysphagic inpatients awaiting VFSS, and facilitated 87 patients to received instrumental assessment who were otherwise unsuitable for VFSS. Speech-led FEES improved service delivery and improved clinical care for patients with dysphagia at St John of God Midland, reducing the likelihood of avoidable hospital readmissions related to dysphagia complications.
Biography
Vanessa has been working as a Speech Pathologist in acute care and rehabilitation services for ten years, both within Australia and in Germany. Her experience with FEES started whilst working in a specialised neurological hospital in Germany. In 2016 she completed her training to become the first Speech Pathologist in the organisation competent in completing all three aspects of the FEES procedure independently (technical, procedural and interpretative competencies). In 2019 she began working at St John of God and was instrumental in the establishment of the FEES service and is passionate about sharing her key learnings from the process.