Harmonization of Flexible Endoscopic Evaluation of Swallowing Practice: Pragmatic Implementation of Outcomes-Focused Procedures in the Acute Hospital Setting.
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| Title: | Harmonization of Flexible Endoscopic Evaluation of Swallowing Practice: Pragmatic Implementation of Outcomes-Focused Procedures in the Acute Hospital Setting. |
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| Authors: | Kostura, Christine1, Strickland, Amber1, Brown, Rebecca2, Langton-Frost, Nicole1,3 nLangto1@jhmi.edu |
| Source: | American Journal of Speech-Language Pathology. Jan2026, Vol. 35 Issue 1, p40-51. 12p. |
| Subject Terms: | *Human services programs, *Interprofessional relations, *Philosophy of education, *Speech-language pathology, *Goal (Psychology), *Comparative studies, *Inter-observer reliability, Medical protocols, Translations, Pilot projects, Hospitals, Treatment effectiveness, Decision making in clinical medicine, Respiratory aspiration, Descriptive statistics, Pharynx, Laryngoscopy, Workflow, Endoscopic gastrointestinal surgery, Electronic health records, Dyes & dyeing, Deglutition, Quality assurance, Deglutition disorders, Critical care medicine, Sensitivity & specificity (Statistics) |
| Abstract: | Purpose: Flexible endoscopic evaluation of swallowing (FEES) is widely used to assess dysphagia in acute care settings; however, there are currently no broadly accepted FEES standardized procedure and interpretation protocols. We identified a need to harmonize FEES practice across one acute care hospital speech-language pathology team with goals to improve consistency, interrater reliability, and clinical decision making. Method: The Translating Evidence Into Practice model was used as a guide for harmonization. This model includes summarizing the evidence, identifying barriers to implementation, measuring performance, and ensuring all patients receive the interventions. Through a review of the literature, we identified validated outcome measures focused on swallow safety, swallow efficiency, and secretion management. Selected outcome measures were integrated into the harmonized FEES procedures, and structured documentation tools were developed to enhance consistency and efficiency. Baseline practices and perceived barriers were assessed through unstructured interviews with SLPs. Training sessions, mentorship, and audits were conducted to support protocol adherence and interrater agreement. Results: Throughout implementation, interrater agreement for outcome measures exceeded 80%. Following the implementation phase, audits revealed the entire procedure was followed 86% of the time, with use of the abbreviated protocol 9% of the time due to safety concerns. Documentation tools were utilized in 100% of cases. SLPs reported improved ease in comparing studies and no significant increase in assessment time. Feedback prompted minor refinements, including updates to documentation tools and a quick-reference guide. Conclusions: Harmonizing FEES practice through a structured approach improved reliability and workflow efficiency and reduced variability. The protocol may facilitate interdisciplinary communication and treatment planning. We suspect that strong stakeholder involvement contributed to successful implementation and adherence. Future efforts could assess the feasibility of implementing this approach at additional institutions. [ABSTRACT FROM AUTHOR] |
| Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Education Research Complete |
| FullText | Links: – Type: pdflink Text: Availability: 0 |
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| Header | DbId: ehh DbLabel: Education Research Complete An: 190920649 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Harmonization of Flexible Endoscopic Evaluation of Swallowing Practice: Pragmatic Implementation of Outcomes-Focused Procedures in the Acute Hospital Setting. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Kostura%2C+Christine%22">Kostura, Christine</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Strickland%2C+Amber%22">Strickland, Amber</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Brown%2C+Rebecca%22">Brown, Rebecca</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Langton-Frost%2C+Nicole%22">Langton-Frost, Nicole</searchLink><relatesTo>1,3</relatesTo><i> nLangto1@jhmi.edu</i> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22American+Journal+of+Speech-Language+Pathology%22">American Journal of Speech-Language Pathology</searchLink>. Jan2026, Vol. 35 Issue 1, p40-51. 12p. – Name: Subject Label: Subject Terms Group: Su Data: *<searchLink fieldCode="DE" term="%22Human+services+programs%22">Human services programs</searchLink><br />*<searchLink fieldCode="DE" term="%22Interprofessional+relations%22">Interprofessional relations</searchLink><br />*<searchLink fieldCode="DE" term="%22Philosophy+of+education%22">Philosophy of education</searchLink><br />*<searchLink fieldCode="DE" term="%22Speech-language+pathology%22">Speech-language pathology</searchLink><br />*<searchLink fieldCode="DE" term="%22Goal+%28Psychology%29%22">Goal (Psychology)</searchLink><br />*<searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br />*<searchLink fieldCode="DE" term="%22Inter-observer+reliability%22">Inter-observer reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+protocols%22">Medical protocols</searchLink><br /><searchLink fieldCode="DE" term="%22Translations%22">Translations</searchLink><br /><searchLink fieldCode="DE" term="%22Pilot+projects%22">Pilot projects</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+making+in+clinical+medicine%22">Decision making in clinical medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Respiratory+aspiration%22">Respiratory aspiration</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Pharynx%22">Pharynx</searchLink><br /><searchLink fieldCode="DE" term="%22Laryngoscopy%22">Laryngoscopy</searchLink><br /><searchLink fieldCode="DE" term="%22Workflow%22">Workflow</searchLink><br /><searchLink fieldCode="DE" term="%22Endoscopic+gastrointestinal+surgery%22">Endoscopic gastrointestinal surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+health+records%22">Electronic health records</searchLink><br /><searchLink fieldCode="DE" term="%22Dyes+%26+dyeing%22">Dyes & dyeing</searchLink><br /><searchLink fieldCode="DE" term="%22Deglutition%22">Deglutition</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+assurance%22">Quality assurance</searchLink><br /><searchLink fieldCode="DE" term="%22Deglutition+disorders%22">Deglutition disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Critical+care+medicine%22">Critical care medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Sensitivity+%26+specificity+%28Statistics%29%22">Sensitivity & specificity (Statistics)</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Purpose: Flexible endoscopic evaluation of swallowing (FEES) is widely used to assess dysphagia in acute care settings; however, there are currently no broadly accepted FEES standardized procedure and interpretation protocols. We identified a need to harmonize FEES practice across one acute care hospital speech-language pathology team with goals to improve consistency, interrater reliability, and clinical decision making. Method: The Translating Evidence Into Practice model was used as a guide for harmonization. This model includes summarizing the evidence, identifying barriers to implementation, measuring performance, and ensuring all patients receive the interventions. Through a review of the literature, we identified validated outcome measures focused on swallow safety, swallow efficiency, and secretion management. Selected outcome measures were integrated into the harmonized FEES procedures, and structured documentation tools were developed to enhance consistency and efficiency. Baseline practices and perceived barriers were assessed through unstructured interviews with SLPs. Training sessions, mentorship, and audits were conducted to support protocol adherence and interrater agreement. Results: Throughout implementation, interrater agreement for outcome measures exceeded 80%. Following the implementation phase, audits revealed the entire procedure was followed 86% of the time, with use of the abbreviated protocol 9% of the time due to safety concerns. Documentation tools were utilized in 100% of cases. SLPs reported improved ease in comparing studies and no significant increase in assessment time. Feedback prompted minor refinements, including updates to documentation tools and a quick-reference guide. Conclusions: Harmonizing FEES practice through a structured approach improved reliability and workflow efficiency and reduced variability. The protocol may facilitate interdisciplinary communication and treatment planning. We suspect that strong stakeholder involvement contributed to successful implementation and adherence. Future efforts could assess the feasibility of implementing this approach at additional institutions. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1044/2025_AJSLP-25-00157 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 12 StartPage: 40 Subjects: – SubjectFull: Human services programs Type: general – SubjectFull: Interprofessional relations Type: general – SubjectFull: Philosophy of education Type: general – SubjectFull: Speech-language pathology Type: general – SubjectFull: Goal (Psychology) Type: general – SubjectFull: Comparative studies Type: general – SubjectFull: Inter-observer reliability Type: general – SubjectFull: Medical protocols Type: general – SubjectFull: Translations Type: general – SubjectFull: Pilot projects Type: general – SubjectFull: Hospitals Type: general – SubjectFull: Treatment effectiveness Type: general – SubjectFull: Decision making in clinical medicine Type: general – SubjectFull: Respiratory aspiration Type: general – SubjectFull: Descriptive statistics Type: general – SubjectFull: Pharynx Type: general – SubjectFull: Laryngoscopy Type: general – SubjectFull: Workflow Type: general – SubjectFull: Endoscopic gastrointestinal surgery Type: general – SubjectFull: Electronic health records Type: general – SubjectFull: Dyes & dyeing Type: general – SubjectFull: Deglutition Type: general – SubjectFull: Quality assurance Type: general – SubjectFull: Deglutition disorders Type: general – SubjectFull: Critical care medicine Type: general – SubjectFull: Sensitivity & specificity (Statistics) Type: general Titles: – TitleFull: Harmonization of Flexible Endoscopic Evaluation of Swallowing Practice: Pragmatic Implementation of Outcomes-Focused Procedures in the Acute Hospital Setting. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Kostura, Christine – PersonEntity: Name: NameFull: Strickland, Amber – PersonEntity: Name: NameFull: Brown, Rebecca – PersonEntity: Name: NameFull: Langton-Frost, Nicole IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Text: Jan2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 10580360 Numbering: – Type: volume Value: 35 – Type: issue Value: 1 Titles: – TitleFull: American Journal of Speech-Language Pathology Type: main |
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