A Transatlantic Comparative Study of Acute Dysphagia Services

Abstract

This was the first study to compare acute dysphagia service provision directly between the UK and the US. It examined variations in acute dysphagia services between the UK and the US, determined clinicians’ perceptions of their own service and that of their transatlantic counterparts, and elicited the reason for variation. An online survey was distributed to randomly-allocated teaching hospitals in the UK and the US, and speech and language therapists working with acute dysphagia responded anonymously via an automated system. Content analysis was employed to convert free-text responses to numeric data, and then this and existing numeric responses were subjected to descriptive statistical analysis. Variability was high, with the US having on average 0.95 whole time equivalent more clinicians per hospital than the UK. This resulted in an increased number of new patients examined and increased frequency of review of existing patients compared to the UK. In contrast, the UK had significantly increased waiting times with no patient being assessed on the same day as referral (compared to 63.6% of US responses). Notable variation was also seen in objective or instrumental assessment, with most US patients receiving videofluoroscopy or fiberoptic endoscopic evaluation of swallowing (compared to only one UK hospital). Finance was found to be at the root of the variation. However, the more extensive US service was found to be more cost-effective.