What Good is the MBSS if the Report is Not so Good?

I think we all get it. 

You work in a facility or for a company that has to send patients our for modifieds or instrumentals of any sort.

It’s Never Easy

You go through the works.   You have to evaluate the patient and try to scour through their paperwork to find out if they’ve had an instrumental.   You talk to the nurses and the DON, the DOR, the doctor and have to jump through a million hurdles just to get the patient out for the instrumental.

You sometimes wait for weeks for your patient to be scheduled and then finally get in for the study.

The Wait is Over…..Or Is It?

The patient comes back to your facility and all they can tell you is they had 2 bites of food and 1 drink and they were told to thicken their drinks.

You get the report (if you’re lucky) and find out that your patient aspirated on thin but not nectar thick (mildly thick) but they did penetrate so they are now on pureed food and honey thick liquids.

Your first thought….What the hell!!  Did they try compensatory strategies?  Did they try to change the bolus size?  Did they try anything?

The Report

You don’t know because it’s not in the report.

You may also not know how they responded to the aspiration, when it happened or why it happened.

The report is everything in the Modified Barium Swallow Study (MBSS).  The report is how the treating SLP knows what is happening and how they build the patient’s treatment plan.

What Happens in the Fluoro Room, Goes in the Report

You see, much like the evaluation you write or the plan of care you carefully create and document, the MBSS report has to be thorough and complete.  If it’s not documented, it didn’t happen.

You complete the best MBSS you know how so make it count with a great report.

Dr. Logemann reported on using compensatory strategies, sensory techniques and multiple trials of a bolus to determine swallowing deficits and how to safely keep the patient eating by mouth if possible.

We may use a chin tuck, head back or head turn to change the physiology of the swallow to improve the patient’s ability to swallow a bolus or even a variety of bolus types.

We may use sensory techniques such as pressure on the tongue, change in size of bolus or change in temperature of bolus to change the swallow.

Let’s Be Honest

The fact of the matter is, if we don’t give the patient a chance to swallow in a variety of ways during the instrumental, we may be sentencing them to thickened liquids or altered food consistencies.  We may be sentencing that patient to dissatisfaction, decreased quality of life, dehydration, malnutrition or even pneumonia.

Who Writes the Report

Palmer et al indicated the report includes a summary of what was done (position of the patient, bolus types presented, strategies trialed), a description of significant structural abnormalities, a summary of the observation of swallowing including each functional component, a diagnostic assessment, and recommendations.   Now, keep in mind, Palmer suggested the physician write the bulk of the report, I think we can agree the SLP writes the entire report.

Utilizing the MBSImP report generator can save time and ensure that you are providing a complete report.   Following a protocol and a report generator can ensure that nothing is forgotten, plus, if you can provide the radiologist with the protocol, it can save that surprise when they don’t understand what you are doing with a patient, which can lead to a discussion in front of the patient/family.

How are the reports in your area?  Good, great, need a little work?  How are the reports you write?

References:

Logemann, J. A. (1997). Role of the modified barium swallow in management of patients with dysphagia. Otolaryngology–Head and Neck Surgery116(3), 335-338.

Palmer, J. B., Kuhlemeier, K. V., Tippett, D. C., & Lynch, C. (1993). A protocol for the videofluorographic swallowing study. Dysphagia8(3), 209-2

Martin-Harris, B., Logemann, J. A., McMahon, S., Schleicher, M., & Sandidge, J. (2000). Clinical utility of the modified barium swallow. Dysphagia15(3), 136-141.

Martin-Harris, B., Logemann, J. A., McMahon, S., Schleicher, M., & Sandidge, J. (2000). Clinical utility of the modified barium swallow. Dysphagia, 15(3), 136-141.

 

 

 

 

2 thoughts on “What Good is the MBSS if the Report is Not so Good?

  1. This is where I’ve been struggling the most! We are all reading that an instrumental is ESSENTIAL to assess pharyngeal swallow physiology and I absolutely agree with that. However, when I review the reports against the video (I always request the video), it never fails to amaze me how different the two are! What’s worse, when I do not agree with the recommendations based on what I assess the pharyngeal function to be (after video review), I very often get heavy pushback from physicians because “that what the SLP who performed the study wrote”. So I’m stuck with a less that accurate assessment of function with non-evidenced based recommendations from the ‘gold-standard assessment’ and my patient suffers for it:(

    Yes, we can contact the SLP and ask the questions like “what did you do x,y,z” and “did you know that the evidence clearly indicates that swallow initiation can occurs anywhere in the pharynx, etc…” BUT my efforts in this are have not been well received. Also, it’s not just 1 – 2 ‘rogue’ clinicians. It’s an entire generation of SLPs who are not competent to do these types of assessments. How to you fight that battle??? I can only say that maybe continuing to raise awareness of this very issue is as good a place as any to start:/

    1. I often wonder why I even request a modified when some of my reports back are terrible. Maybe offer the physicians a list of gold-standard recommendations with references to support your changes?? Unfortunately there is no standard for dysphagia at this time and anyone who “feels” competent and can answer some questions in the correct manner can assess and treat. There’s no real accountability and it seems not a lot of concern from the top about having competent SLPs doing the modifieds. Hopefully we’ll get there!! Keep your head up and using your skills!!

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