Why should swallow screenings be done?
Why do we bother with the swallow screenings and not just move on to a full assessment? Research has actually shown that the earlier we identify individuals who are potentially struggling with dysphagia – specifically, the aspiration component - the better they do. The earlier we identify the risk and get interventions going, the better these folks do over the long run. A screening allows for that early identification because a screening can be done even if the SLP is not available.
Another reason for a screening is that it allows for more accurate referrals for full assessments. In facilities that do not do screenings, referrals to speech pathology are made based on what the nurse thinks should be done or what the doctor thinks should be done, and whether or not they think we could contribute something useful. We do not necessarily want to be dependent on another individual's practice patterns. Screenings allow those referrals to be accomplished in a more objective way.
A third rationale for screenings is that they help us identify patients who are at high risk of aspiration. When I say “we,” I am not just talking about SLPs; rather, I mean “we” as the healthcare team. Screenings help the nurse and the doctor on the floor, or the emergency room (ER) physician or ER nurse, identify those folks who are at high risk so that we can get some supports and plans in place, regardless of whether the SLP is readily available.
Alternately, screenings help to facilitate return to oral feeding and oral medication. If the screening is being done in the emergency room at three o'clock in the morning, and the client passes the screen, he can then have that sandwich that he wants, or she can take the medications that the physician feels are important to get in. If the team waits for the SLP to come, it might be hours before the patient is able to get those medications or return to eating. In other words, if patients pass the screening, they are able to return to oral feeding and get their medications earlier. Overall, then, it is just a more efficient way of approaching dysphagia in a healthcare setting. It helps to identify those at-risk people more quickly, and we do not have to put restrictions in place for longer than they need to be. Additionally, screenings give us better referrals in the long run so that we can use the time we do have for assessment more efficiently.
Please refer to the SpeechPathology.com course, Back to Basics: Swallow Screening: How, when, and who, for more information on making informed, evidence-based choices regarding appropriate screening tools specific to their particular patient populations and settings.