Harmonization of FEES: Outcomes-focused procedures (Kostura et al., 2025)

<p dir="ltr"><b>Purpose: </b>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.</p><p dir="ltr"><b>Method: </b>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.</p><p dir="ltr"><b>Results:</b> 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.</p><p dir="ltr"><b>Conclusions:</b> 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.</p><p dir="ltr"><b>Supplemental Material S1. </b>Assessment 1 example: Review of FEES video.</p><p dir="ltr"><b>Supplemental Material S2.</b> Assessment 4: Spreadsheet utilized to audit 100 consecutive patient charts focusing on use of the harmonized FEES procedure, use of the selected outcome measures, and use of the documentation tools.</p><p dir="ltr">Kostura, C., Strickland, A., Brown, R., & Langton-Frost, N. (2025). Harmonization of flexible endoscopic evaluation of swallowing practice: Pragmatic implementation of outcomes-focused procedures in the acute hospital setting. <i>American Journal of Speech-Language Pathology. </i>Advance online publication. <a href="https://doi.org/10.1044/2025_AJSLP-25-00157" rel="noreferrer" target="_blank">https://doi.org/10.1044/2025_AJSLP-25-00157</a></p>