Do I Really Not Have Access to Instrumental?

It’s the never-ending soapbox.   I know.  There was probably even an eye-roll at seeing this article.

All.  The.  Time.

Did you get an instrumental?  Well, why not?   You don’t know anything without the instrumental.

Reason Numero Uno

The number one reason, that I’ve seen for not obtaining an instrumental is no access.   The SLP wants an instrumental, but they are either told no by their facility or there is no facility even remotely close enough to send the patient.

There are times that the SLP does not request an instrumental because they already “know” the patient is aspirating.

Learn to Advocate

In the references is a link to a phenomenal guide by Theresa Richard for advocating for an instrumental for your patient.  Please look at that!

Do the Math

Administrators are in the business of business.  They have a facility to maintain and make sure that they stay open so they are always interested in the numbers.

These can be easy enough to obtain with a little hard work.   Look at how many patients are on thickened liquids.   How much does the facility pay for those thickened liquids.   Especially if the facility buys pre-thickened liquids, thickened liquids can cost a facility.

Let’s Look at Rehospitalization

How much is spent on rehospitalization?  This can be a cost also in loss of revenue from the patient not being in your facility.  What is the primary reason for rehospitalization and is it avoidable and something that can be prevented through dysphagia treatment?

Look at the numbers of how many patients  are misdiagnosed.   If you are changing diets at bedside, we may be overdiagnosing up to 70% of the time.   That means a large majority of those assessed at bedside only, may be on thickened liquids for no reason at all!!  This creates unnecessary expense to the facility.

It All Adds Up

When you add the cost of thickened liquids or the cost of rehospitalization vs. the cost of one instrumental assessment, your facility should be able to see the benefit.

Also, if you can show the numbers, that if you are able to obtain a good report and then treat the patient, often these patients can be rehabilitated with more than the usual list of oral motor exercises.

Going Mobile

The other great thing is that instrumental assessments are mobile.  You can often use mobile MBSS or mobile FEES to assess patients at a fraction of the cost of sending the patient to the hospital for the exam.

Do your research, crunch the numbers and be that squeaky wheel to get appropriate care for your patients!

References:

The Step-by-Step Guide to Advocating For Access to Instrumentation for Our Patients

Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging. 2012;7:287-298. doi:10.2147/CIA.S23404.

Attrill, S., White, S., Murray, J., Hammond, S., & Doeltgen, S. (2018). Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC health services research18(1), 594.

Ekberg, O., Hamdy, S., Woisard, V., Wuttge–Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia, 17(2), 139-146.

Patel, D. A., Krishnaswami, S., Steger, E., Conover, E., Vaezi, M. F., Ciucci, M. R., & Francis, D. O. (2017). Economic and survival burden of dysphagia among inpatients in the United States. Diseases of the Esophagus, 31(1), dox131.

Bonilha, H. S., Simpson, A. N., Ellis, C., Mauldin, P., Martin-Harris, B., & Simpson, K. (2014). The one-year attributable cost of post-stroke dysphagia. Dysphagia29(5), 545-552.

Bours, G. J., Speyer, R., Lemmens, J., Limburg, M., & De Wit, R. (2009). Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. Journal of advanced nursing, 65(3), 477-493.

 

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