Videofluoroscopic Swallow Study (VFSS) in the real-word: Who does and does not receive a VFSS in the acute-care setting?
Sara Bolt1, Tia Croft1,2, Katrina Speechley1, Kate Short1,3,4,9, Belinda Kenny3, Bridget Meyer1, Anna Corry5, Maigen Bright6, Emma Paisley7, Vanessa Crebert8, Joseph Descalla9, Elise Baker2,3,91Liverpool Hospital, SWSLHD, Sydney, NSW, Australia2Allied Health SWSLHD, Sydney, NSW, Australia3Western Sydney University, Sydney, NSW, Australia4Primary and Community Health, SWSLHD, Sydney, NSW, Australia5Bankstown Hospital, SWSLHD, Sydney, NSW, Australia6Campbelltown and Camden Hospitals SWSLHD. , Sydney, NSW , Australia7Fairfield Hospital, SWSLHD, Sydney, NSW, Australia8Bowral Hospital, SWSLHD, Bowral, NSW, Australia9Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
Abstract
Background: Videofluoroscopy Swallow Studies (VFSS) are considered the gold standard assessment for management of patients with suspected dysphagia. Anecdotally, only a small proportion of adult inpatients receive a VFSS in acute care settings. Access to VFSS may be impacted by service demands, clinician decision making and patient factors. However, characteristics of inpatients who do or do not receive a VFSS are not well understood.
Aims: (1) To identify the proportion of adult acute inpatients referred for a swallowing assessment who receive a VFSS. (2) To describe the characteristics of adult acute inpatients with suspected oropharyngeal dysphagia who receive a VFSS.
Method: A practice-based research approach explored VFSS referral practice in acute care. Data collection was conducted by 47 speech pathologists across 5 hospitals. A prospective file audit of routine care was conducted across two one-month periods for all acute inpatients referred for a swallow assessment. Age did not influence who received a VFSS.
Results: 1136 patients were referred for dysphagia assessment in the timeframe, with 7% subsequently receiving a VFSS. The characteristics that influenced those who received a VFSS include hospital site, clinical area (particularly neurosciences and respiratory), sex, and rating of functional oral intake status.
Discussion: Although VFSS is recommended as the gold standard assessment for patients with oropharyngeal dysphagia, our findings confirm anecdotal reports that the proportion of patients who receive a VFSS in the acute setting is low. Both facility and patient factors influenced who receives a VFSS. Clinicians’ decision making about this complex issue requires exploration.
Biography
Tia Croft is the District Director of Speech Pathology for South Western Sydney Local Health District and the Head of Department for Speech Pathology at Liverpool Hospital. Tia has over 20 years of experience leading and managing speech pathology teams. She is the Coordinating Principal Investigator for this project