Outcomes of Flexible Endoscopic Evaluation of Swallowing Implementation in Acute Care

This study examined the impacts of introducing flexible endoscopic evaluation of swallowing (FEES) into an acute care hospital already equipped for videofluoroscopic swallowing study (VFSS). We evaluated how FEES implementation influenced total instrumental exam volume, intensive care unit (ICU) exam completion rate, repeat exams, and the time from order of instrumental assessment to exam completion.

A retrospective observational study was conducted at a Level 1 trauma center comparing instrumental swallowing assessment activity across temporally matched 5-month periods in 2022 and 2023, before and after FEES implementation. Data for FEES and VFSS were extracted from billing records and chart reviews. Descriptive and inferential statistics (chi-square, Mann-Whitney U, linear regression) assessed changes in exam patterns.

Total instrumental exam volume increased by 25% following FEES implementation (297-370 exams), with stable VFSS rates and 61 additional FEES examinations. ICU instrumental examination completion doubled (7.1%-15.1%). Total repeat exam count increased by 64%, while the proportion of patients receiving repeats rose from 18% to 21% (p = .30). Among ICU patients, FEES exams were completed significantly faster than VFSS post-FEES implementation (M = 1.2 vs. 2.3 days, p < .001); this was not the case outside the ICU (p = .38).

The introduction of FEES expanded completion of instrumental swallowing assessments, particularly for ICU patients, without displacing existing VFSS services. FEES supplemented diagnostic capacity, improved timeliness, and increased clinical flexibility. These data can support advocacy efforts for integrating FEES as a complementary tool in acute care dysphagia management, even where VFSS exists.