[Dysphagia] MBS issues

[ronewman at columbus.rr.com (Robert Newman)]

Just a comment or two about this subject.  I have been on both sides of this fence.  Get to know your acute care mbs therapist(s).  Call them before and/or after the exam. Give them more than an hour before the test--say a day or two--to give time for a call back.  I am primarily on the acute care side these days. We try some strategies, but quite frankly, a lot of nursing home or even home health patients cannot consistently follow verbal directions. I cannot say that pt x is able to safely eat with chin tiuck/ head tilt / etc. if he can only do that one out of various tries. We set ourselves up for failure and liability. We actually do look at all info. sent to us--how else can one test without dx and background info. If I don't have it, I call and ask for it.  If a patient has various s/s of dysphagia by hx, however, does not exhibit these during the MBS exam at  the hospital, there is nothing else to be reported. I cannot make a person show me s/s if he is not experiencing them at that point in time. I will note reported hx, make appropriate referrals ( if applicable), otherwise, no therapuetic recommendations if not seen while I am examining the pt. Remember, the MBS is a test with many limitations, many of which has been discussed on the listserve.

Communication is the key. Talk with your manager and see if he will allow you to do some marketing on company time. Go to the one or two hospitals with which you would prefer to work, set up a mtg with the slps, and lay out your expectations. Bring examples of what cases/reports have been good. If you are able to put forth this effort, it will pay off in the long run. You and your  pts/families will reep the benefits.

good luck, 

Kelly L. Newman, CCC-SLP
Columbus, Ohio