Implementation and evaluation of speech pathology-led referring process for videofluoroscopic swallow studies

Shana Taubert1, Dr  Clare Burns1, Professor Elizabeth Ward2,3, Lynell Bassett1, Dr  Linda Porter4, Penni Burfein1

1Speech Pathology & Audiology, Royal Brisbane & Women’s Hospital, Brisbane, Australia, 2School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 3Centre for Functioning & Health Research, Metro South HHS, Brisbane, Australia, 4Medical Imaging, Royal Brisbane & Women’s Hospital, Brisbane , Australia

BACKGROUND: While speech pathologists (SPs) routinely conduct videofluoroscopic swallow studies (VFSS) to inform dysphagia treatment, only doctors are authorised to complete Medical Imaging Request forms. This process increases doctors’ low level procedural duties and can delay patient access to VFSS. An Expanded Scope Practice (ESP) model of care, where SPs complete VFSS Medical Imaging Request Forms, exists in some hospitals. However, evaluation of this model has not been reported.

AIMS: To implement a SP-led VFSS referring process for inpatients at a quaternary hospital and evaluate 1) safety and efficiency of this model; 2) perceptions of treating SPs, ward doctors and radiologists; and 3) perceptions of the ESP SPs.

METHODS: Phase 1: The ESP model was endorsed by Medical Imaging and key hospital stakeholders. Three months of baseline data was collected to examine existing referring processes and adherence by doctors to statutory radiation safety requirements for completing VFSS Medical Imaging Request Forms.

Phase 2: Four SPs with VFSS experience completed two hours training, developed in consultation with Medical Imaging and international practice, to undertake the ESP role of completing VFSS Medical Imaging Request Forms.

Phase 3: Referral processes were examined prospectively for 6 months post implementation of the ESP model. Post implementation, stakeholders completed semi-structured interviews and the service model implementation analysed using the Consolidated Framework for Implementation Research (CFIR) constructs.

RESULTS: Phase 1 data revealed multiple issues with the current medical referring model. Data collection from Phase 3 is nearing completion for 100 patients in the ESP model. Results will be reported regarding efficiency and safety of the ESP model and SP/medical staff perceptions.

DISCUSSION: Evaluation of the implementation of a SP-led VFSS referring model has helped to resolve current issues with VFSS referrals. Data describing the prospective use of this model will help inform future widespread service implementation.


Shana is a senior speech Pathologist at Royal Brisbane & Women’s Hospital. She is currently undertaking her PhD on the topic of “Enhancing speech pathology practice in videofluoroscopic swallow studies”.

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