Working together to help patients with dysphagia

When patients with swallowing difficulties, known as dysphagia, receive care at Joseph Brant Hospital (JBH), our care teams work together from symptom onset/identification to discharge to assess and treat them.

Dysphagia can be caused by different conditions like stroke, acquired brain injury, degenerative diseases, brain tumours, muscular or nerve disorders, structural disorders, gastrointestinal conditions or respiratory conditions. When a patient is admitted, a healthcare team member may note or suspect swallowing difficulty, which can be screened by nurses through observation. In specific units like the stroke unit, a formal screening tool should be automatically ordered by the physician. Sometimes patients or their families will report swallowing difficulty to the healthcare team.

Once dysphagia is identified, a referral is made to a Speech-Language Pathologist (SLP), who will work together with a Registered Dietitian (RD) to create a care plan. We spoke to Diala, an RD and Chloe, an SLP, about the care they provide:  

“I’ll first meet with the patient and assess their swallowing function. In some cases further investigation is needed. This may include x-ray or scoping to obtain a video of the patient’s swallowing abilities,” said Chloe. “Based on the results, I’ll decide whether any changes in diet texture are needed. If they are, I’ll work closely with Diala, so she can ensure the patient is receiving adequate hydration and nutrition with the diet texture recommendations that I’ve made.”

“As a Registered Dietitian, I prioritize ensuring patients with dysphagia receive adequate therapeutic nutrition and hydration to maintain their overall wellbeing. This also helps manage their underlying medical conditions,” said Diala. “I also work with the hospital’s food service department to ensure patients receive safe food textures and adequate nutrition. The goal is to help patients achieve their baseline diet texture, while also receiving optimal nutrition. This helps to promote their overall recovery, medical stability and quality of life.”

Nutrition research reflects that 95% of patient with dysphagia are at risk of malnutrition. The RD assesses the nutritional status and oral intake adequacy for patients with dysphagia. If a patient is unable to consume food by mouth, the care team will consider the patient’s goals of care, medical prognosis and quality of life before discussing with the patient’s family the risks and benefits of alternative nutrition therapy. This includes either providing nutrition through a feeding tube (Enteral Nutrition) or, when the digestive tract can’t be used, providing (Parenteral Nutrition) through a peripherally inserted central catheter (PICC) line into a vein in the patient’s arm.

During a patient’s assessment and recovery, Chloe and Diala review recommendations and monitor for any signs of improvement. As patients improve, they may transition slowly from modified textures to regular solids and fluids according to the International Dysphagia Diet Texture Guidelines Standards. Modified textures may include purees (e.g., apple sauce, pudding), moist minced (e.g., egg salad, cottage cheese), to soft/bite sized (e.g., pasta, fish) to regular solids (e.g., salads, cookies).

“To be able to take a drink to quench one’s thirst is something we take for granted all too often and until someone is in the situation in which they cannot safely eat or drink, they may not realize just how important it is to them” said Chloe.

Once patients can successfully manage regular solids and thin fluids, they may be ready to be discharged from speech-language pathology and dietitian services. Before discharge, Diala Provides education and recommendations for texture modified diets (i.e. foods allowed, others to avoid) and nutritional supplements for ongoing nutrition optimization.

For those needing ongoing support, referrals to community and outpatient speech-language pathologist and dietitian services are made. This ensures continuity of care and that their swallowing and nutrition goals are supported.

During Dysphagia Awareness Month, we highlight and thank our teams at JBH who provide quality, patient-centred care to those with this condition.