What are the Benefits of Flexible Endoscopic Evaluation of Swallowing?
NDoscopy Dysphagia Specialists provide expert care in dysphagia management. NDoscopy Dysphagia Specialists provide a research based, outcome-driven FEES service to guide patients and facilities in managing dysphagia. We provide a more objective means of quantifying dysphagia, including penetration and aspiration, residue and reflux. Our measures allow for functional tracking of patient outcomes. Contact us for more information about data tracking to show swallowing progress in therapy.
When a Clinical Bedside Swallow isn't enough...
A clinical bedside swallow evaluation is an important component in the diagnostic process. Just as a neurologist examines a patient prior to sending him out for a MRI or EMG, an SLP should examine the patient prior to FEES. The bedside allows SLPs to identify patients who warrant an instrumental evaluation. It also allows the SLP to trial and teach different interventions that will be tested to determine if they work during the instrumental.
However, a clinical bedside is often not enough to treat patients effectively and reduce hospital admissions from dysphagia related illnesses. Many patients require more in-depth testing to understand the cause of the dysphagia and how to treat it. A bedside cannot tell us anything about swallowing physiology. For example, we cannot quantify hyolaryngeal excursion or determine if there is a delay from a bedside swallow. Without an instrumental assessment, we cannot determine if there is vallecular or pyriform residue. And even though there may be clinical signs, we cannot verify that there is aspiration. It is just not possible to conclude this from bedside assessments.
Aspiration and silent aspiration rates are especially high in patients with tracheostomy with studies showing up to 87% aspiration rates and up to 83% silent aspiration (Elpern, 1994). In stroke patients, instrumental assessments have documented aspiration rates of 40% (Daniels, 1998; Kidd, 1993). Silent aspiration can occur in 40-70% of patients with dysphagia who aspirate. Dysphagia and aspiration are common in these patients and is often missed with bedside evaluations. This is concerning with dysphagia contributing to 4 of the 5 top reasons for re-hospitalization including CHF, respiratory infections, UTIs and electrolyte imbalance (Coleman, 2004). Pneumonia is also a potential consequence of dysphagia due to aspiration in a fragile population. Pneumonia is the leading cause of death in skilled nursing facilities. Inaccurate diagnosis of dysphagia is a preventable contributor to repeat hospital admissions. Relying on bedside evaluations also often results in over-diagnosis of dysphagia and unnecessary restrictive diets, placing patients at risk of malnutrition and dehydration. Furthermore, modified diets and thickened liquids are costly at about $7000 per year.
That’s where NDoscopy Dysphagia Specialists can help! NDSS directly view the swallowing process using FEES to provide evidenced based diet and treatment recommendations. We provide ongoing collaboration with the interdisciplinary team to identify and reduce dysphagia related complications and improve patient outcomes. FEES testing can also assist with safely upgrading a patient’s diet and eliminating the costs associated with modified diets as well as improving quality of life. We travel directly to the patient to provide these benefits and also have a private practice location.
We offer the following benefits to our partners
- Simplified Scheduling: referrals accepted by phone, text, or email with no lengthy forms to complete.
- Timely FEES Procedure: we typically average 1-2 business days from referral. Emergent FEES can frequently be performed the same day.
- Materials/Supplies: we bring all of our own food, liquids, and supplies to reduce your preparation time. We will gladly use any other specific items you would like tested during the study.
- Advanced Equipment: our FEES system uses LED technology and high definition image quality during the study with color images included on each report.
- Immediate Results: we print our comprehensive, outcome driven reports on site before leaving the facility.
- Evidence-Based Decannulation Input: Information pertaining to if a patient with a tracheostomy may be a candidate for tracheostomy removal as it relates to the swallow and cough mechanism.
- Increased SLP Productivity: we only bill for FEES allowing the treating SLP to bill for swallow evaluation/treatment in the same day. We encourage facility SLPs to be present and participate in the study.
- Simple Billing: we bill one flat rate for each completed FEES. No charge for cancelled studies, travel, or stat referrals. If we are unable to pass the scope, there will not be a charge.
- Educational Opportunities: we offer complimentary in-services to our partner facilities on a variety of topics including normal swallowing function, dysphagia, eating with tracheostomy and mechanical ventilation, free water protocol, and oral care.
- Ongoing consultation: we offer ongoing consultation and support for staff, patients and families
Advantage of FEES
- Assessment of secretion management
- No need to transport the patient for the procedure. We come to you.
- The patient can eat typical foods and liquids, and even a full meal if indicated to assess for fatigue.
- Cost effective. The test is 1/4 of the price of a Modified Barium Swallow Study. No transportation costs or missed visits.
- Assessment of the structures and physiology of the swallow to determine a treatment plan. We visualize the swallow while the patient eats.
- Immediate results with images provided. Video can also be provided upon request.
- Treating SLP can bill for dysphagia treatment on the same day.
- No radiation compared to MBS.