With 98 swallow screening tools already developed, dysphagia remains under-screened and
undiagnosed. Even for patients at high risk of oropharyngeal dysphagia (i.e.,
hospitalized aged, post-stroke, Parkinson's disease, head and neck cancer, or those had ≥
48 hours of endotracheal intubation), swallow screening is not systematically performed.
Nurses, as front-line providers, are bombarded with patients' dysphagia. We witnessed
patients' subsequent poor outcomes, including delayed oral intake, dependence on the
feeding tube, increased pneumonia, prolonged hospital length of stay, and increased
in-hospital.
Despite many calls for nurses to perform bedside screens for timely management, there is
a lack of census on what tools to use (98 available, many claimed to be valid) and
whether nurses are capable of safely performing these screens, especially when facing
across-disease patients. Without a screening tool that is used universally across
different diseases to assess whether patients can safely engage in oral intake, clinical
healthcare professionals will face significant challenges in conducting the screening.
Meanwhile, we found the common, shared items, i.e., consciousness, voice/speech,
coughing, oral motor movements, and water drinking tests or swallowing trials, are
included in most swallow screening tools, suggesting these items are essential basics for
oral intake safely.
Therefore, instead of creating a new screening tool, the aim of this study is to extract
the common, shared items among existing swallowing screening tools and assemble them into
a swallow screening protocol that can be administered by nursing staff for triage whether
inpatient populations are at risk of unsafe for oral intake. After conducting a
systematic review and assessing the quality, we found the Yale Swallow Protocol was
identified as a high-quality swallowing screening tool and was used for screening the
risk of aspiration across diverse outpatients who were referred for further swallow
assessment. However, whether the Yale Swallow Protocol can be implemented in acute care
settings to screen for "oral intake" requires further warranted for its applicability.
Therefore, this study aims to test the applicability (i.e., accuracy, responsiveness,
time-spending, and safety) of the Yale Swallow Protocol when used to screen for 'oral
intake,' with speech therapists' evaluations serving as the reference standard for
inpatients across various disease categories.