title: Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists.
abstract: Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.
authors.affiliation: Speech Pathology, School of Health Sciences, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia. sue.mcallister@flinders.edu.au.
authors.forename: Sue
authors.identifier: 0000-0003-1597-0563
authors.initials: S
authors.lastname: McAllister
authors.affiliation: Speech Pathology and Audiology, Flinders Medical Centre, Southern Area Local Health Network, Adelaide, SA, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Kruger
authors.affiliation: Speech Pathology, School of Health Sciences, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Doeltgen
authors.affiliation: Speech Pathology and Audiology, Flinders Medical Centre, Southern Area Local Health Network, Adelaide, SA, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Tyler-Boltrek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D000067716:Point-of-Care Testing / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013066:Speech-Language Pathology / Q000379:methods* / Q000592:standards; D063189:Symptom Assessment / Q000379:methods* / Q000592:standards
keywords: Clinical bedside assessment; Clinical reasoning; Deglutition; Deglutition disorders; Dysphagia; Validity