Authors (including presenting author) :
Chan S(1), Chan B(1), Ku P(2)(3)(4), Wong E(5), Tong M(4)
Affiliation :
(1)Speech Therapy Department, Prince of Wales Hospital, (2)United Christian Hospital, (3)Tseung Kwan O Hospital, (4)Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, (5)Department of Ear, Nose & Throat, Prince of Wales Hospital
Introduction :
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is an internationally recognized dysphagia diagnostic tool. It also provides biofeedback for swallowing rehabilitation. In Prince of Wales Hospital, speech therapists (ST) are developing a two-arm FEES service to meet patients’ needs. The head and neck (H&N) arm has been established for more than 20 years, in which ENT specialists, with ST’s support, conducted FEES on H&N patients who might need surgical intervention. With the experience gained, a new arm, ST-led FEES, in which ST conducted FEES after formal training and with ENT’s medical support, was developed in 2018 for patients who required FEES for swallowing assessment and rehabilitation.
Objectives :
This study aimed to evaluate the efficacy of ST-led FEES in terms of service accessibility, safety, patients’ benefits and patients’ satisfaction.
Methodology :
A retrospective study was conducted on the ST-led FEES service from September, 2018 to November, 2019. The outcome measures included waiting time for instrumental swallowing assessment, potential complication incidents (life-threatening and minor), number of patients discharged after FEES and patients’ satisfaction surveyed by questionnaires.
Result & Outcome :
Seventy-four procedures were attempted. All were completed without complications. With this new service, the waiting time for instrumental swallowing examination of these patients was shortened by 1.9 months. Among these patients, 12.2% of them who originally required regular follow-ups based on bedside examination alone were discharged after FEES. The response rate of the patient satisfaction survey was 100%. Analysis of the questionnaires revealed no unacceptable pain or discomfort during FEES and 97.3% of the patients rated excellent or good in overall satisfaction. In conclusion, the new service model was a success in both quality and safety aspects. It enhanced dysphagic patients’ access to FEES for examination and training, thus shortening the waiting time for instrumental swallowing assessment, improving the efficiency and effectiveness of rehabilitation, and facilitating early discharge. The model also demonstrated proper allocation of resources and best application of different professional expertise to manage patients’ dysphagia, with ENT specialists focusing on surgical intervention and ST on rehabilitation.
