Weighing up the pros and cons of dysphagia triage in South Africa

Abstract

Background: Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap. Objectives: To establish the reliability and validity of a researcher-developed dysphagia triage checklist. Method: A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist. Results: Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes. Conclusion: The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia. Contribution: The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.

Keywords

• dysphagia
• triage
• emergency unit
• south africa
• speech–language therapy
• evidence-based practice
• dysphagia triage