Let’s be honest — we’ve all been on the hunt for that quick, simple, and reliable screen to help flag potential dysphagia.

We want something easy to administer, not just for us SLPs, but something we can teach other professionals to use as part of a streamlined referral process. Bonus points if it doesn’t require an hour and a half or a full swallow study setup.

If you’re in acute care, especially in a stroke-certified building, chances are you’re already evaluating every stroke patient who walks (or wheels) through the door. So what if we had a tool to help guide those referrals more effectively?

Enter: The Yale Swallow Protocol — formerly known as the 3-Ounce Swallow Test.

---

Where Did the 3 Ounces Come From?

This protocol is grounded in research exploring how much liquid it takes to reliably elicit a cough response in someone with dysphagia. Three ounces turned out to be the “magic number” — just enough to trigger a response without being overwhelming for the average patient.

It’s not just about guzzling water. The Yale Swallow Protocol integrates cognition and oral mech screening to help ensure that the test results are meaningful.

---

What’s Included in the Protocol?

Before the patient even touches the water, you’ll assess:

• Oral motor function – Are the oral structures intact and functional?
• Cognition – Can the patient follow 1-step directions? Can they answer yes/no questions reliably?

Here’s why that matters:
According to Leder, Suiter, and Warner (2009), patients who are not oriented ×3 are 31% more likely to aspirate.

Even more eye-opening — if the patient can’t follow a 1-step direction:

• Aspiration of liquids increases to 57%
• Aspiration of purees rises to 48%
• Risk of being unsafe for any oral consistency hits 69%

That’s a huge deal.

---

Administering the Yale Swallow Protocol

It really is this simple:

1. Give the patient 3 ounces (90 cc) of room temperature water in a cup.
2. Ask them to drink it all without stopping.
3. Observe carefully.

They pass if:

• They drink all 3 ounces without stopping
• No coughing or overt signs of swallowing difficulty during or immediately after

They fail if:

• They can’t finish the 3 ounces in one go
• They cough during or immediately after drinking

Easy to remember. Easy to teach. Backed by solid evidence.

---

When NOT to Use the Yale Swallow Protocol

Like any tool, it’s not for everyone. Skip it for patients who are:

• Medically unstable
• Experiencing severe respiratory distress
• Known to have severe dysphagia
• Already aspirated on previous bolus trials
• Unable to manage their own secretions

In these cases, you’re going to want to tread more cautiously and consider instrumental evaluation ASAP.

---

Want to Learn More?

If this protocol piques your interest (and it should), there are tons of ways to dig deeper:

• 🎓 Take a CEU course with Debra Suiter on MedBridge
• 📚 Buy the book: The Yale Swallow Protocol: An Evidence-Based Approach to Decision Making by Leder & Suiter (available on Amazon)
• 🎧 Listen to Debra Suiter on the Swallow Your Pride podcast Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

  Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

---

References

• DePippo, K. L., Holas, M. A., & Reding, M. J. (1992). Validation of the 3-oz water swallow test for aspiration following stroke. Archives of Neurology, 49(12), 1259–1261.
• Suiter, D. M., & Leder, S. B. (2008). Clinical utility of the 3-ounce water swallow test. Dysphagia, 23(3), 244–250.
• Garon, B. R., Engle, M., & Ormiston, C. (1995). Reliability of the 3-oz water swallow test utilizing cough reflex as sole indicator of aspiration. Journal of Neurologic Rehabilitation, 9(3), 139–143.
• Suiter, D. M., Leder, S. B., & Karas, D. E. (2009). The 3-ounce (90-cc) water swallow challenge: A screening test for children with suspected oropharyngeal dysphagia. Otolaryngology—Head and Neck Surgery, 140(2), 187–190.
• Suiter, D. M., Sloggy, J., & Leder, S. B. (2014). Validation of the Yale Swallow Protocol: A prospective double-blinded videofluoroscopic study. Dysphagia, 29(2), 199–203.
• Suiter, D. M., & Leder, S. B. (2009). 3 Ounces Is All You Need. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 18(4), 111–116.
• Warner, H. L., Suiter, D. M., Nystrom, K. V., Poskus, K., & Leder, S. B. (2014). Comparing accuracy of the Yale Swallow Protocol when administered by registered nurses and speech‐language pathologists. Journal of Clinical Nursing, 23(13-14), 1908–1915.
• Leder, S. B., & Suiter, D. M. (2014). The Yale Swallow Protocol: An Evidence-Based Approach to Decision Making. Springer.
• Leder, S. B., Suiter, D. M., & Warner, H. L. (2009). Answering orientation questions and following single-step verbal commands: Effect on aspiration status. Dysphagia, 24(3), 290.