Variability in Flexible Endoscopic Evaluation of Swallowing Documentation Templates: A Cross-Sectional Database Study

Area of Science:

• Medical Informatics
• Speech-Language Pathology
• Gastroenterology

Background:

• Electronic health records (EHRs) are increasingly used in healthcare, but documentation practices can vary widely.
• Flexible endoscopic evaluation of swallowing (FEES) is a key diagnostic tool for dysphagia, requiring consistent documentation for effective patient care.
• Variability in FEES documentation may hinder inter-institutional collaboration and research.

Purpose of the Study:

• To describe the variability in flexible endoscopic evaluation of swallowing (FEES) documentation within electronic health record (EHR) systems across multiple healthcare institutions.
• To assess the extent to which standardized components and rating scales are incorporated into FEES documentation templates.

Main Methods:

• A search of the Epic Community Library identified 243 unique adult inpatient FEES templates from 475 institutions.
• Templates were evaluated against a 16-component checklist based on comprehensive FEES guidelines.
• The inclusion of standardized scales for secretions, residue, and penetration-aspiration was assessed.

Main Results:

• Trial consistencies, pharyngeal phase assessment, and penetration-aspiration assessment were the most frequently documented components.
• Dye color, sensory testing, and hypopharyngeal reflux were the least frequently documented.
• Standardized scales for penetration-aspiration, secretions, and residue were used in 46.5%, 24.3%, and 19.3% of templates, respectively.

Conclusions:

• Significant variability exists in FEES documentation across institutions using a shared EHR platform.
• There is a need to promote standardization in FEES reporting to enhance dysphagia evaluation, management, and multi-institutional research.
• Standardized FEES documentation can facilitate clinical collaborations and improve patient care for swallowing disorders.