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

The purpose of this study was to describe the variability in flexible endoscopic evaluation of swallowing (FEES) documentation in the electronic health record (EHR) system across multiple health care institutions.

The terms [(flexible OR fiberoptic) AND (endoscopic evaluation of swallowing) OR (SLP FEES)] were used to search the Epic Community Library, a shared database of user-created templates for 475 institutions using the Epic EHR. Templates for adult inpatient FEES were included. The content of each template was evaluated against a checklist of 16 components derived from Susan Langmore's comprehensive FEES guidelines. The use of standardized approaches for rating secretions, residue, and penetration-aspiration was also assessed.

Two hundred forty-three unique templates were identified. The most frequently included components were trial consistencies (n = 201, 82.7%), assessment of the pharyngeal phase of swallow (n = 182, 74.9%), and assessment of penetration-aspiration (n = 180, 74.1%). The least frequently included components were dye color (n = 37, 15.2%), sensory testing (n = 73, 30.0%), and hypopharyngeal reflux (n = 78, 32.1%). Standardized scales for penetration-aspiration, secretions, and residue were included in 46.5% (n = 113), 24.3% (n = 59), and 19.3% (n = 47) of templates, respectively. There were no significant differences in the inclusion of standardized scales between templates from university-affiliated and non-university-affiliated institutions.

There are similarities and differences in FEES documentation across institutions using a common EHR platform, with substantial variability in the incorporation of standardized tools. Promoting standardization in FEES reporting is critical for not only improving dysphagia evaluation and management but also enabling multi-institutional research and clinical collaborations to care for patients with swallowing conditions.