FREQUENTLY ASKED QUESTIONS
WHAT IS DYSPHAGIA?
Dysphagia is a medical term referring to difficulty in swallowing. Many problems can arise in muscles and nerves between the mouth and the stomach that may cause Dysphagia. Older adults are at a higher risk for swallowing difficulties but it can occur at any age.
IS IT RESEARCH BASED?
If you are interested in what research says, we would be happy to email you a list of journal article for any of the following areas:
Supports the need for instrumental swallowing evaluations
Comparison of FEES vs. MBSS
Information obtainable through FEES
Safety of FEES
Comfort during FEES
Reducing hospital re-admissions
IS IT SAFE?
FEES has shown that it is an extremely safe, well tolerated, and dynamic procedure that is rightfully becoming more widely accepted and utilized across all populations. The utility and flexibility of FEES is helping to reduce the rate of complications from dysphagia while aiding to restore patients to their normalized oral intake. With FEES we are also able to view excess secretions and signs and symptoms of laryngopharyngeal reflux (LPR), two conditions that are not viewed on an MBSS, but are very prevalent in the geriatric population. Unlike MBSS, FEES does NOT expose the patient to radiation or barium.
FAQ - FACILITIES
WHY DOES MY FACILITY NEED FEES?
Research has shown a 70% error rate in bedside swallowing exams where recommendations were either too restrictive (unnecessary thickening of liquids/NPO), leading to dehydration/malnutrition, or silent aspiration leading to pneumonia was missed. You would never want a physical therapist to tell your grandmother who has a suspected broken hip to get out of that bed and walk without an X-ray, in the same way that Speech Pathologists cannot make appropriate recommendations without imaging (FEES/MBSS). We need to see the anatomical and pathophysiological deficits in order to make the appropriate recommendations. Some exercises and strategies such as thickened liquids have been shown to actually cause harm to a patient and potentially a subsequent re-hospitalization, if they are indicated for an unnecessary reason. Once we have obtained baseline imaging, then we can use our clinical judgement to form a treatment plan.
HOW CAN FEES IMPROVE QUALITY OF CARE?
The following five conditions – congestive heart failure (CHF), upper respiratory infections (URI), urinary tract infections (UTI), sepsis, and electrolyte imbalance -all account for 78% of all 30-day SNF re-hospitalizations, and have all been deemed as potentially avoidable. CHF can be reduced by adherence to any fluid or dietary restrictions. URIs may be reduced by following appropriate positioning of residents with swallowing problems to avoid aspiration that could lead to pneumonia. UTIs, sepsis, and electrolyte imbalance can all result from dehydration or poor nutrition, which may be prevented with careful monitoring of patient fluid and nutrient intake. All of these have been found to be preventable with a mobile FEES procedure. Nothing good happens when the patient does not agree with or is not capable of following the recommended diet or compensatory strategies.
HOW CAN IT HELP CUT COSTS?
Often patients come from the hospital on a modified diet and/or thickened liquids and as their overall condition approves, a diet upgrade is often necessary, but the diet upgrade doesn’t always occur. Some patients can live at a SNF for several months, and even years before a family member stirs the pot to see if they may be appropriate for an upgrade. The cost of keeping 1 patient, just 1 out of 100s of residents in your facility on thickened liquids for 1 year costs approximately $7,000 in annual operating costs. Just think of how many residents may be living at your facility that have been on thickened liquids for an extended period of time! Also keep in mind, that overall physical condition has no correlation in requiring thickened liquids. The oldest, weakest, and frailest of them all have been known to live out their years happily drinking thin liquids.
So to help you recap: You can spend upwards of $1600 to send your patient to a hospital for an MBSS that can NOT visualize some of the conditions that are prevalent in the geriatric population, then spend upwards of $35,000+++ for a re-hospitalization, then when they come back from the hospital on thickened liquids, you can tack on $7,000 that year to cover the cost… Or you can spend a couple hundred dollars to have a mobile FEES done at the facility.
A recent study found that SNFs that have access to mobile FEES show a significant increase in instrumental assessments, and subsequently a significant reduction in pneumonia rates in that same group.
FAQ - SLPS
I'VE ALWAYS USED MBSS. WHY FEES?
Research shows that MBSS and FEES have a 97-100% inter-rater reliability. FEES has been show to have a higher specificity and severity in identifying penetration, aspiration, residue, and spillage. FEES will also allow for trials of specific foods or strategies. Unlike MBSS, FEES does not have a time restriction and you can watch the entire study. The endoscopist will provide continued support following the study to help you develop an appropriate treatment plan.
CAN THE SLP STAY FOR THE STUDY?
We encourage SLP’s to join us in the study. It allows for better understanding of the swallow function with various food trials. The SLP can assist by feeding the patient as the study is being performed and try compensatory strategies to develop treatment. Time spent during the study can be billed and used toward RUG minutes with the exception of the time the scope in the nasal cavity (usually 10-15 minutes). We also welcome nurses and physicians to stay to better understand swallowing deficits.
IS IT DIFFICULT TO GET ON THE SCHEDULE?
Once a facility contract is signed, all that we need is a quick text, email, or call to make an appointment. When the endoscopist arrives all that is needed is a copy of the order and a face sheet. When possible, we would like for the SLP to be available for verbal review of results and to assist us with the study.