Refining the Protocol and Clinical Pathway for Oesophageal Screening in Videofluoroscopic Swallow Studies: An Examination of Clinical and Operational Impacts Over Five Years.

Abstract

Current international practice guidelines recommend videofluoroscopic swallow studies (VFSSs) include oesophageal screening. However, the clinical application of oesophageal screening is not well established. A multidisciplinary dysphagia team at one hospital refined their oesophageal screening protocol and clinical pathway over five years, exploring clinical and operational impacts. Retrospective chart audits were conducted for 100 consecutive 2024 VFSS patients (refined protocol group). VFSS reports, gastroenterologist (GE) consultations and clinical pathway adherence were compared to previously published VFSS cohorts at the research site (pre-protocol group, 2019-20, n = 100; protocol group, 2020-21, n = 160). There were no differences between the three groups for age (p > .05) or oropharyngeal dysphagia severity (p > .05). Rates of oesophageal screening significantly increased (p < .001) following protocol introduction. In the refined protocol group, there was a significant increase (83% versus 6%, p < .001) in speech-language pathologists (SLPs) providing oesophageal strategy advice and no difference in patient VFSS radiation dose (p > .05) compared to the protocol group when oesophageal screening was conducted. There was no difference between the three groups for new GE consultation rates (p > .05). Post-audit, SLP + GE case discussions were added to the clinical pathway to allow for more individualised management of complex patients. The refined oesophageal screening protocol and clinical pathway expanded clinician understanding of patients' dysphagia by marrying reported symptoms with VFSS findings and led to targeted intervention without adverse impacts. Ongoing work is required to further optimise multidisciplinary dysphagia team collaboration and patient outcomes.