SPARC: Speech Pathology led Flexible Endoscopic Evaluation of Swallowing (FEES) service delivery model in the acute inpatient setting: does a refined model of care enhance access to instrumental assessment and expedite optimal patient outcomes?
Tracks
6
Acute care – adult
Adult
Assessment
Dysphagia
Flexible endoscopic evaluation of swallowing (FEES)
Innovative practice
Swallowing
| Saturday, June 14, 2025 |
| 10:55 AM - 11:05 AM |
Overview
Eva Norman
Details
⏫ In-practice
⏲️ 10.55am - 11.15am
⌛20-minutes
📚 Assumed knowledge of attendees: Intermediate (Some previous learning/working knowledge of topic e.g. treated a few cases)
⏲️ 10.55am - 11.15am
⌛20-minutes
📚 Assumed knowledge of attendees: Intermediate (Some previous learning/working knowledge of topic e.g. treated a few cases)
Presenter
Mrs Eva Norman
Royal Prince Alfred Hospital
SPARC: Speech Pathology led Flexible Endoscopic Evaluation of Swallowing (FEES) service delivery model in the acute inpatient setting: does a refined model of care enhance access to instrumental assessment and expedite optimal patient outcomes?
10:55 AM - 11:15 AMPresentation summary
Background: Timely and comprehensive swallowing assessment allows safe, efficacious treatment to prevent dysphagia/aspiration related morbidity, expedite outcomes and minimise economic burden. Speech Pathology (SP)-led Flexible-Endoscopic-Evaluation-of-Swallowing (FEES) is a cost-efficient repeatable instrumental swallowing examination, however often limited by available resources.
Aim: To explore the impact of a refined SP-led FEES Model-of-Care (MOC) on (1) access to FEES and, (2) time to commence rehabilitation and achieve dysphagia recovery milestones, in the acute inpatient hospital setting.
Methods: Observational dual-site cohort study. The eMR of all patients admitted to two tertiary-hospitals across two 6-month periods (pre and post-implementation of the refined SP-led FEES MOC) and referred to SP for dysphagia were reviewed. Those who received FEES as part of routine care formed the final cohort. Service and dysphagia outcome data were extrapolated and compared across time periods; number of FEES, clinical and dysphagia characteristics, dysphagia rehabilitation and pattern of recovery.
Results: Implementation of the refined SP-led FEES MOC resulted in a 185% increase in FEES (pre n=13; post n=37). Days to FEES reduced from a mean of 15-days to 7-days. Swallow rehabilitation was commenced earlier at a mean of 31-days versus 7-days. In those who were nil-by-mouth following initial SP assessment, days to commencing oral intake (if able) reduced from a mean of 25-days to 9-days, however there was no change to duration of enteral feeding. Frequency of repeat FEES to support management increased from 15% to 23%. Swallowing management changed in 92% following FEES across cohorts for ≥1 parameters (e.g. change in diet/fluid recommendations, implementation/change in compensatory/therapeutic strategies). No preventable aspiration related complications after FEES or FEES related complications were recorded.
Conclusions: The refined SLHD SP-led FEES service delivery MOC improved access to FEES, facilitated earlier targeted dysphagia rehabilitation and commencement of oral intake, thus potentially facilitating safer and more efficient dysphagia recovery.
Aim: To explore the impact of a refined SP-led FEES Model-of-Care (MOC) on (1) access to FEES and, (2) time to commence rehabilitation and achieve dysphagia recovery milestones, in the acute inpatient hospital setting.
Methods: Observational dual-site cohort study. The eMR of all patients admitted to two tertiary-hospitals across two 6-month periods (pre and post-implementation of the refined SP-led FEES MOC) and referred to SP for dysphagia were reviewed. Those who received FEES as part of routine care formed the final cohort. Service and dysphagia outcome data were extrapolated and compared across time periods; number of FEES, clinical and dysphagia characteristics, dysphagia rehabilitation and pattern of recovery.
Results: Implementation of the refined SP-led FEES MOC resulted in a 185% increase in FEES (pre n=13; post n=37). Days to FEES reduced from a mean of 15-days to 7-days. Swallow rehabilitation was commenced earlier at a mean of 31-days versus 7-days. In those who were nil-by-mouth following initial SP assessment, days to commencing oral intake (if able) reduced from a mean of 25-days to 9-days, however there was no change to duration of enteral feeding. Frequency of repeat FEES to support management increased from 15% to 23%. Swallowing management changed in 92% following FEES across cohorts for ≥1 parameters (e.g. change in diet/fluid recommendations, implementation/change in compensatory/therapeutic strategies). No preventable aspiration related complications after FEES or FEES related complications were recorded.
Conclusions: The refined SLHD SP-led FEES service delivery MOC improved access to FEES, facilitated earlier targeted dysphagia rehabilitation and commencement of oral intake, thus potentially facilitating safer and more efficient dysphagia recovery.
Refrences
Ajemian, M. S., Nirmul, G. B., Anderson, M. T., Zirlen, D. M., Kwasnik, E. M.(2001) Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation - Implications for management. Archives of Surgery, 136:434-7
Attrill, S., White, S., Murray, J., Hammond, S., & Doeltgen, S. (2018). Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Services Research, 18(1), 1-18
Bax, L., McFarlane, M., Green, E., & Miles, A. (2014). Speech- Language Pathologist- led Fiberoptic Endoscopic Evaluation of Swallowing: Functional Outcomes for Patients after Stroke. Journal of Stroke, 23(3):e195-200
Borders, J. C., Fink, D., Levitt, J. E., McKeehan, J., McNally, E., Rubio, A., et al. (2019). Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure. Dysphagia, 34:521-8
Eltringham, S. A., Kilner, K., Gee, M., Sage, K., Bray, B. D., Pownall, S., Smith C. J. (2018) Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review. Cerebrovasc Dis, 46 (3-4): 97–105. https://doi.org/10.1159/000492730
Hafner, G., Neuhuber, A., Hirtenfelder, S., Schmedler, B., Eckel, H. E. (2008) Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. Eur Arch Otorhinolaryngol, 265:441-6
Scheel, R., Pisegna, J. M., McNally, E., Noordzij, J. P., Langmore, S. E. (2016). Endoscopic assessment of swallowing after prolonged intubation in the ICU setting. Anals of otology, Rhinology & Laryngology, 125(1):43-52
Schefold, J. C., Berger, D., Zürcher, P., Lensch, M., Perren, A., Jakob, S. M., & Takala, J. (2017). Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Critical care medicine, 45(12), 2061-2069
Speech Pathology Australia. (2019). Flexible Endoscopic Evaluation of Swallowing (FEES) Clinical Guideline. The Speech Pathology Association of Australia. Melbourne
Zuercher, P., Moret, C. S., Dziewas, R., & Schefold, J. C. (2019). Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Critical care, 23(1), 103
Attrill, S., White, S., Murray, J., Hammond, S., & Doeltgen, S. (2018). Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Services Research, 18(1), 1-18
Bax, L., McFarlane, M., Green, E., & Miles, A. (2014). Speech- Language Pathologist- led Fiberoptic Endoscopic Evaluation of Swallowing: Functional Outcomes for Patients after Stroke. Journal of Stroke, 23(3):e195-200
Borders, J. C., Fink, D., Levitt, J. E., McKeehan, J., McNally, E., Rubio, A., et al. (2019). Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure. Dysphagia, 34:521-8
Eltringham, S. A., Kilner, K., Gee, M., Sage, K., Bray, B. D., Pownall, S., Smith C. J. (2018) Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review. Cerebrovasc Dis, 46 (3-4): 97–105. https://doi.org/10.1159/000492730
Hafner, G., Neuhuber, A., Hirtenfelder, S., Schmedler, B., Eckel, H. E. (2008) Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. Eur Arch Otorhinolaryngol, 265:441-6
Scheel, R., Pisegna, J. M., McNally, E., Noordzij, J. P., Langmore, S. E. (2016). Endoscopic assessment of swallowing after prolonged intubation in the ICU setting. Anals of otology, Rhinology & Laryngology, 125(1):43-52
Schefold, J. C., Berger, D., Zürcher, P., Lensch, M., Perren, A., Jakob, S. M., & Takala, J. (2017). Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Critical care medicine, 45(12), 2061-2069
Speech Pathology Australia. (2019). Flexible Endoscopic Evaluation of Swallowing (FEES) Clinical Guideline. The Speech Pathology Association of Australia. Melbourne
Zuercher, P., Moret, C. S., Dziewas, R., & Schefold, J. C. (2019). Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Critical care, 23(1), 103
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Eva Norman is a Clinical Specialist Speech Pathologist in Critical Care at Royal Prince Alfred Hospital, with 18 years’ experience working in NSW Health. During her career, Eva has held various senior clinical, leadership and management roles. Eva has been instrumental in the development, implementation and evaluation of policies/procedures and service change in several clinical areas including critical care, respiratory, tracheostomy management and instrumental voice and swallow assessment clinics. Eva is a co-chair of the NSW Tracheostomy and Critical Care EBP Group and member of the NSW FEES Working Party. Eva is an experienced clinical educator and an emerging researcher. She was a successful recipient of the Sydney Local Health District Allied Health Seeding Grant in 2022 for research investigating the swallow profile of patients with COVID-19 using FEES. She is a co-author on her first paper accepted for publication in 2023, exploring service delivery for dysphagia post endotracheal extubation.
The information contained in this program is current at of the time of publishing but is subject to changes made without notice.
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