Creating a Swallow Screening Program at Mass General Hospital: A Model for Development and Implementation

The Massachusetts General Hospital-Swallow Screening Tool (MGH-SST) is a two-part dysphagia screening tool for use by trained staff working with acute neuroscience patients. It was developed in 2004 for use on our neuroscience inpatient units using factors sensitive to aspiration risk. The MGH-SST provides early detection of those at risk for aspiration, guides the decision whether a patient can safely eat or drink, and acts as a trigger for appropriate speech--language pathology (SLP) consult for a comprehensive swallow evaluation. A staff education module was developed including a training video with clinical examples to simulate disordered clinical features, as well as a competency assessment. The MGH-SST was validated using trained nurses with patients with a broad range of neurological and neurosurgical injuries, comparing the MGH-SST results to an instrumental dysphagia assessment, fiberoptic endoscopic evaluation of swallowing (FEES). It was found to be a valid and effective screening to identify patients at risk for dysphagia. Elements critical to the success of a dysphagia screening program include multi-disciplinary collaboration, administrative support, comprehensive training to ensure reliable and consistent administration, and continuous performance measurements.