Swallowing screening is a minimally invasive procedure that enable quick determination of
Swallowing screening procedures indicate the presence of clinical signs and symptoms that may be indicators of dysphagia, with a focus on identifying overt signs of aspiration.
It is important to note that, currently, no bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several tools have demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols have not been established (O’Horo et al., 2015).
There is no preferred dysphagia screening procedure. Screening procedures are usually used to determine the possible presence of dysphagia and the need for further investigation.
Screening procedures may include the following:
For further information regarding screening procedures for patients with stroke, see Summary of the Systematic Review in the ASHA Evidence Maps.
If there is an indication of increased risk of dysphagia, then the screening procedure is typically terminated and a referral to speech-language pathology is initiated for comprehensive swallowing assessment. It is common for precautions (e.g., dietary precautions, no oral intake) to be put into place while the patient is waiting for further assessment.
There are several potential models for swallowing screening, many of which involve collaboration with other members of the clinical team. Some approaches include the following:
Trained medical professionals should be available 24 hours a day, 7 days a week to complete screenings. A delay in screening the patient for safety of oral intake can delay administration of oral medications. The emergency department physician, admitting physician, or nursing staff might be selected to complete the screening. If the speech-language pathology staff are selected to perform the screening, procedures will have to be established to ensure timeliness. Policies and procedures for documenting the results of swallowing screening should be established by the facility.
Training other professionals refers to educating non-SLP clinical staff (e.g., nursing) to conduct swallowing screening. Such education could lead to earlier identification of dysphagia and referrals for further SLP evaluation. If the SLP is to conduct the initial swallowing screening, then expertise in the area of dysphagia and familiarity with current literature should suffice in order to conduct a competent swallowing screening at bedside. If the screening is to be conducted by other health care personnel (e.g., nurse, physician), training requirements will vary by facility. A competency evaluation should be included in the training process. The SLP’s involvement might include monitoring quality outcomes for the screening program. If the SLP is to be the primary trainer, then the content of the training will depend on the model or protocol that will be employed. A basic description of the anatomy and physiology of deglutition—as well as a list of the signs and symptoms of dysphagia—are usually included in any training program.
Cross-training refers to specific training provided to service providers (e.g., SLPs) in a department or capacity in which they do not typically work.
SLPs should be involved in establishing dysphagia screening programs, as the SLP is the preferred provider of dysphagia treatment and diagnosis. SLPs should make evidence-based decisions as they work with a facility to design a screening program.
The SLP may initially contact nursing administration to discuss the role of nursing staff in designing a screening program. The process may also be initiated as a joint/interdisciplinary performance improvement project. The SLP may also contact the medical education office and identify which physicians or specialists might be appropriate for a discussion of this nature. In some instances, the most appropriate party may be a senior medical resident or the chair of the neurology service. It is important for the SLP to contact key players among nursing and physician staff. Initial calls and/or meetings may serve to further guide the process of development and/or implementation.
The SLP department might analyze patient data to determine the following data points:
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