Ms Amanda Judson1, Dr Nicola Clayton1,2,3, Ms Chelsea Larkman1, Mrs Eva Norman4
1Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia, 2School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia, 3Faculty of Health Sciences, University of Sydney, Sydney, Australia, 4Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia
Dysphagia is common among older persons with incidence rates between 27-91% >70 years. Videofluoroscopic Swallowing Study (VFSS) is recognised as the gold standard for instrumental dysphagia assessment and informing subsequent swallowing treatment. Change in service delivery models in aged care has seen an increase in the application of VFSS, however, the impact on patient outcomes and service efficiency is not well understood.
To evaluate the impact of increased application of VFSS on patient outcomes and service efficiency.
A retrospective medical record audit was conducted over two time periods (July 2018–June 2019) and (July 2019–June 2020), reflective of two different service models (group 1: usual care vs group 2: enhanced VFSS referral). Key data points included: swallowing related outcomes (Functional Oral Intake Scale [FOIS]) score, diet and fluid recommendation change and Speech Pathology occasions of service (OOS). Comparisons were then drawn between the two groups.
VFSS referral occurred following Speech Pathology initial assessment in 24 of 653 (group 1: 3.67%) compared to 47 of 526 (group 2: 8.94%). FOIS score changed following VFSS in both cohorts (group 1: 33.32% and group 2 36.16%). Furthermore, VFSS resulted in diet (49.99% and 63.82%) and fluid (33.32% and 44.68%) change across groups 1 and 2 respectively. The mean OOS per episode of care was 4.29 for group 1 and 3.98 for group 2.
This study suggests that VFSS remains a valuable tool for guiding dysphagia management in the aged care population and may expedite patient care.
Amanda Judson is a Senior Speech Pathologist in Aged Care and Rehabilitation at Concord Hospital in Sydney. She has extensive experience in the management of older persons with dysphagia in the acute hospital environment and is an integral member of the Multidisciplinary Aged Care team.