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Dysphagia

, Volume 31, Issue 5, pp 650–662 | Cite as

Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists

  • Sue McAllisterEmail author
  • Samantha Kruger
  • Sebastian Doeltgen
  • Emma Tyler-Boltrek
Original Article

Abstract

Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.

Keywords

Deglutition Deglutition disorders Clinical bedside assessment Clinical reasoning Dysphagia Validity 

Notes

Acknowledgments

Our grateful thanks to our speech language pathology colleagues for their support and diligent participation in this research.

This research was conducted without financial support.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Speech Pathology, School of Health SciencesFlinders University of South AustraliaAdelaideAustralia
  2. 2.Speech Pathology and Audiology, Flinders Medical CentreSouthern Area Local Health NetworkAdelaideAustralia

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