The development of an oropharyngeal dysphagia team

Abstract

Successful treatment of the dysphagic patient is dependent on the knowledge base of the healthcare team and the early recognition of the swallowing disorder. If not diagnosed and treated properly, dysphagia can lead to death from pneumonia secondary to aspiration. Untreated dysphagia can also lead to unnecessary tube feedings. The clinical nutrition staff and speech/language pathologists recognized the need for a multidisciplinary team to provide the proper feeding protocol for patients with oropharyngeal dysphagia. An Oropharyngeal Dysphagia Healthcare Team was organized consisting of the dietitians, speech/language pathologists, and registered nurses from neurology and rehabilitation units. A physician advisory panel was formed to solicit support and to advise on the teams function. Through bi-weekly meetings, an 82 page Clinical Handbook was developed to assist in educating staff and to serve as a reference guide. Copies of the handbook are available on all nursing units. Comprehensive flow charts were developed to outline the process of the team functions from identification of patient to therapeutic modalities needed to discharge. The concept of the team approach was presented to the physicians at Medical and Surgical Grand Rounds. Inservices were conducted on all nursing units and other ancillary departments. When a dysphagia team consult is ordered, the speech/language pathologist conducts a bedside screening and determines what feeding protocol is necessary and if further testing is needed. The dietitian completes a nutritional assessment, including tube feeding if needed. The team can proceed without further consult with the physician. The physician is kept up to date by the Dysphagia Team notes in the progress notes in patients medical chart. Menus have been developed, dependent on consistency needed by patient. Data comparison has been made from a 2 month period — January/February 1993 and January/February 1994. There have been 16 Dysphagia Team consults. Of the 16 Dysphagia Team consults received, only 1 was inappropriate. This one was referred for gastrointestinal consult for esophageal dysphagia. A 46% increase in speech/language pathologist consults and 43% increase in the number of Modified Barium Swallows completed. Revenues received from the speech department from increases in speech referrals for 1 month were $24,000; an increase of $17,974. In one year, 28 dysphagia patients started on tube feedings were advanced to regular diets. The Dysphagia Team meets weekly to discuss all patients and updates written in the patients medical chart. This multidisciplinary team has been successful in providing high quality, cost effective care and education to patients with swallowing difficulties.