Thinking outside the (voice) box – implementing telehealth to make FEES accessible

Ms Meaghan Cracknell1, Ms Rebecca  Lindhe1, Dr Sarju Vasani1

1The Prince Charles Hospital, Brisbane, Australia

Fibreoptic Endoscopic Evaluation of Swallowing (FEES) is an instrumental assessment used to evaluate swallowing function and guide the treatment of dysphagia. It has been used in clinical practice since 1988.

The Prince Charles Hospital (TPCH) is a major cardio-thoracic tertiary hospital, where prior to 2015, FEES was not available, and when patients required this procedure urgently, it necessitated an inter-hospital transfer to another facility.  A review of referral trends estimated that 1-2 patients per week would have benefited from a FEES procedure to enhance the management of their dysphagia. TPCH already had a well-established videofluoroscopy (VFSS) clinic, however changes in patient populations and presentations over the years made FEES a highly desirable addition.  Anecdotally it had been observed that post cardiothoracic surgery and heart and lung transplants, patients often experienced coexisting dysphonia and dysphagia, making FEES highly desirable over VFSS.

Historically, nasendoscopy has routinely been used by Medical Officers to assess the larynx. However, as FEES is a procedure to assess swallow function and safety, and not the anatomy and physiology of the larynx, Speech Pathologists are credentialed to perform FEES procedures independently.  This allows increased numbers of patients access to a gold standard assessment.

Whilst a Speech Pathology led FEES clinic is not novel, the TPCH model of care is. The hospital wide FEES service is conducted in the absence of an ENT program on site. By initiating and implementing an asynchronous tele-heath service model, supported by the ENT program at another facility within MNHSS, TPCH have successfully overcome both the governance and geographical barriers to providing a routine FEES service. Utilising a tele-health model has not only allowed our hospital to establish a FEES service but subsequently provided our patients with the same care, in the same location, aligning with the health service’s strategy of putting people first.


Meaghan Cracknell is a Speech Pathologist who has worked in a variety of clinical roles at tertiary level hospitals both within Australia and the UK.  Her current role is an Advanced Speech Pathologist at The Prince Charles Hospital in Brisbane within the Intensive Care Unit.

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