Adult dysphagia services in acute and subacute settings in Singapore

Figures & data

Table 1. Demographics and clinical load of speech-language pathologists.

Demographic and clinical load	Acute (n = 51)		Subacute (n = 17)		All (n = 68)
	%	(n)	%	(n)	%	(n)
Employment status
Full-time	86.3	(44)	88.2	(15)	86.8	(59)
Part-time	13.7	(7)	5.9	(1)	11.8	(8)
No response	0	(0)	5.9	(1)	1.5	(1)
Experience working in dysphagia services
0–5 years	52.9	(27)	64.7	(11)	55.9	(38)
More than 5 years	47.1	(24)	35.3	(6)	44.1	(30)
Percentage of caseload dedicated to dysphagia
1–50%	7.8	(4)	0	(0)	5.9	(4)
51–75%	33.3	(17)	29.4	(5)	32.3	(22)
76–100%	56.9	(29)	70.6	(12)	60.3	(41)
No response	2	(1)	0	(0)	1.5	(1)
Clinical caseloads managed^a
General and/or geriatric medicine	88.2	(45)	88.2	(15)	88.2	(60)
Neurology and/or neurosurgery	82.4	(42)	94.1	(16)	85.3	(58)
Respiratory medicine	72.5	(37)	82.4	(14)	75	(51)
Cancer	54.9	(28)	41.2	(7)	51.5	(35)
Cardiac medicine	43.1	(22)	58.8	(10)	47.1	(32)
General surgery	47.1	(24)	5.9	(1)	36.8	(25)
Critical care	41.2	(21)	–	–	30.9	(21)
Emergency department	7.8	(4)	–	–	5.9	(4)
Other	7.8	(4)	17.6	(3)	10.3	(7)
No. of practice setting
1	31.4	(16)	52.9	(9)	36.8	(25)
2	41.2	(21)	17.6	(3)	35.3	(24)
3 or more	27.4	(14)	29.4	(5)	27.9	(19)

Note: Bold indicates highest frequency responses; ^aTotal percentages >100% as multiple choices could be selected.

Table 2. Dysphagia referral practices reported by speech-language pathologists.

Referral practices	Acute (n = 51)		Subacute (n = 17)		All (n = 68)
	%	(n)	%	(n)	%	(n)
Main referral source*
Medical doctors	90.2	(46)	100	17	92.6	(63)
Allied health professionals	5.9	(3)	0	(0)	4.4	(3)
Nurses	2	(1)	0	(0)	1.5	(1)
No response	2	(1)	0	(0)	1.5	(1)
Prioritization of referrals*
No prioritization	19.6	(10)	29.4	(5)	22.1	(15)
Based on clinical characteristics and urgency	66.7	(34)	58.8	(10)	64.7	(44)
Based on a formal prioritization framework	13.7	(7)	5.9	(1)	11.8	(8)
No response	0	(0)	5.9	(1)	1.5	(1)
Waiting time for initial assessments^#
Less than a day	58.8	(30)	82.4	(14)	64.7	(44)
1–2 days	29.4	(15)	11.8	(2)	25	(17)
3–6 days	5.9	(3)	0	(0)	4.4	(3)
A week or more	5.9	(3)	0	(0)	4.4	(3)
No response	0	(0)	5.9	(1)	1.5	(1)

Note: Bold indicates highest frequency responses; *p > .05; ^#U = 285, p = .031.

Table 3. Nature of dysphagia screening practices reported by speech-language pathologists.

Screening practices	Acute (n = 44)		Subacute (n = 5)
	%	(n)	%	(n)
Screening criteria^#
All new admissions	4.5	(2)	20	(1)
Patients who fulfil specific criterions (e.g., clinical pathways)	81.8	(36)	40	(2)
No standard criteria	4.5	(2)	40	(2)
Other (e.g., dependent on medical team’s concerns)	6.8	(3)	0	(0)
No response	2.3	(1)	0	(0)
Professionals who conducted screening^a
Medical doctor	61.4	(27)	80	(4)
Nurse	90.9	(40)	40	(2)
Speech and language pathology assistant	2.3	(1)	0	(0)
Screening tools^a
Published screening tool	18.2	(8)	20	(1)
Screening tool developed by speech pathology department	68.2	(30)	40	(2)
Informal screening tools, not developed by speech pathology department	25	(11)	60	(3)
Other	13.6	(6)	20	(1)

Note: Bold indicates highest frequency responses; ^#p = .039; ^aTotal percentages >100% as multiple choices could be selected.

Table 4. Instrumental assessments services reported by speech-language pathologists (SLPs).

Instrumental assessment services	Acute				Subacute
	VFSS		FEES		VFSS		FEES
	%	(n)	%	(n)	%	(n)	%	(n)
All respondents from the acute (n = 51) and subacute (n = 17) settings
Local availability and accessibility (including access at other sites)
Available and accessible	86.3	(44)	72.5	(37)	35.3	(6)	35.3	(6)
Available, but difficult to access	9.8	(5)	19.6	(10)	5.9	(1)	5.9	(1)
Not available, but easy to access	3.9	(2)	2	(1)	29.4	(5)	5.9	(1)
Not available, difficult to access	0	(0)	0	(0)	29.4	(5)	35.3	(6)
Not available, not accessible	0	(0)	2	(1)	0	(0)	17.6	(3)
No response	0	(0)	3.9	(2)	0	(0)	0	(0)
Respondents who had at least some availability and accessibility to instrumental assessments.
Acute setting (VFSS n = 51; FEES n = 48); subacute setting (VFSS n = 17; FEES n = 14)
Utilization frequency
Never/rarely	3.9	(2)	22.9	(11)	29.4	(5)	64.3	(9)
Sometimes	31.4	(16)	50	(24)	52.9	(9)	35.7	(5)
Often/always	64.7	(33)	27.1	(13)	17.6	(3)	0	(0)
Waiting time for assessment
1–2 days	11.8	(6)	39.6	(19)	11.8	(2)	14.3	(2)
3–6 days	52.9	(27)	39.6	(19)	41.2	(7)	28.6	(4)
1–2 weeks	31.4	(16)	20.8	(10)	23.5	(4)	14.3	(2)
2 weeks to a month	3.9	(2)	0	(0)	17.6	(3)	14.3	(2)
More than a month	0	(0)	0	(0)	5.9	(1)	7.1	(1)
No response	0	(0)	0	(0)	0	(0)	21.4	(3)
Reasons preventing utilization^a
Patient declined due to safety concerns	29.4	(15)	56.3	(27)	23.5	(4)	50	(7)
Patient declined due to cost	56.9	(29)	25	(12)	58.8	(10)	28.6	(4)
Medical team did not give approval	31.4	(16)	18.8	(9)	11.8	(2)	14.3	(2)
Patient support not available	5.9	(3)	12.5	(6)	5.9	(1)	7.1	(1)
SLPs not trained in procedure	–	–	22.9	(11)	–	–	35.7	(5)
Other	41.2	(21)	41.7	(20)	29.4	(5)	7.1	(1)

Note: Bold indicates highest frequency responses; VFSS = Videofluoroscopic swallowing study; FEES = Fiberoptic endoscopic evaluation of swallowing; ^aTotal percentages >100% as multiple choices could be selected.

Table 5. Dysphagia recommendations and perceived adherence reported by speech-language pathologists.

Utilization and perceived adherence	Acute (n = 51)		Subacute (n = 17)		All (n = 68)
	%	(n)	%	(n)	%	(n)
Utilization of management strategies
Compensatory strategies
Never/rarely	2	(1)	0	(0)	1.5	(1)
Sometimes	13.7	(7)	17.6	(3)	14.7	(10)
Often/always	84.3	(43)	82.4	(14)	83.8	(57)
Traditional rehabilitation
Never/rarely	0	(0)	17.6	(3)	4.4	(3)
Sometimes	39.2	(20)	23.5	(4)	35.3	(24)
Often/always	60.8	(31)	58.8	(10)	60.3	(41)
Device assisted therapy
Not available	7.8	(4)	29.4	(5)	13.2	(9)
Never/rarely	43.1	(22)	35.3	(6)	41.2	(28)
Sometimes	39.2	(20)	35.3	(6)	38.2	(26)
Often/always	9.8	(5)	0	(0)	7.4	(5)
Perceived adherence and agreement
Dietary modifications
Never/rarely	0	(0)	0	(0)	0	(0)
Sometimes	25.5	(13)	17.6	(3)	23.5	(16)
Often/always	72.5	(37)	82.4	(14)	75	(51)
No response	2	(1)	0	(0)	1.5	(1)
Swallowing strategies
Never/rarely	13.7	(7)	23.5	(4)	16.2	(11)
Sometimes	68.6	(35)	29.4	(5)	58.8	(40)
Often/always	13.7	(7)	41.2	(7)	20.6	(14)
No response	3.9	(2)	5.9	(1)	4.4	(3)
Rehabilitation
Never/rarely	17.6	(9)	11.8	(2)	16.2	(11)
Sometimes	62.7	(32)	35.3	(6)	55.9	(38)
Often/always	13.7	(7)	52.9	(9)	23.5	(16)
No response	5.9	(3)	0	(0)	4.4	(3)
Continue dysphagia care
Never/rarely	0	(0)	0	(0)	0	(0)
Sometimes	21.6	(11)	0	(0)	16.2	(11)
Often/always	78.4	(40)	100	(17)	83.8	(57)

Note: Bold indicates highest frequency responses.

Table 6. Service barriers described by speech-language pathologists.

Theme	Example responses
Staffing constraints and high workload	‘Lack of manpower. Lack of time. Too much pressure on delivering stats of patients seen instead.’ [SLP 48]
	‘High caseloads and admin portfolios, leaving insufficient time to think deeply about patient management or remain abreast of latest research to improve patient care’ [SLP 2]
Limited accessible resources	‘Lack of resources’ [SLP 32] ‘Lack of access to instrumentals and devices’ [SLP 51]
Breakdown in communication across services	‘Communication is not always streamlined/clear across different healthcare clusters.’ [SLP 36]
	‘Incomplete information, difficult process of getting information from other institutions’ [SLP 4]
Lack of dysphagia knowledge and support among other healthcare professionals	‘Lack of awareness of speech therapy services, lack of support from team to support dysphagia rehabilitation.’ [SLP 7]
	‘Lack of multidisciplinary collaborations/understanding between the medical doctors and the therapists.’ [SLP 41]
Suboptimal professional and organizational culture	‘Reduced visibility to higher management, having to fight for things like VFSS frame rate.’ [SLP 13]
	‘Resistance towards change.’ [SLP 52]
Limited professional development opportunities	‘Lack of further training opportunities for staff.’ [SLP 66] ‘Lack of manpower to provide quality service and also have time for training, projects etc.’ [SLP 13]
Patients and family factors	‘Patients have to pay for whatever service we provide – may be a financial burden’ [SLP 59]
	‘Patient refusal’ [SLP 11]

Note: VFSS = Videofluoroscopic swallowing study; SLP = speech-language pathologist.