Adult dysphagia services in acute and subacute settings in Singapore

Abstract

International studies examining dysphagia management have identified that a degree of practice variability exists globally, with multiple factors within the local health service context influencing the nature of services. Understanding current practices and service inefficiencies is a foundational step for service optimization. Thus, this study aimed to understand service characteristics and issues associated with adult dysphagia service provision within acute and subacute settings in Singapore. Two online anonymous surveys were conducted with: (a) managers to explore practice documents used to guide dysphagia services, and (b) speech-language pathologists (SLPs) to understand dysphagia practices and service issues. Data were analyzed using descriptive statistics and content analysis. Responses from 12 managers and 68 SLPs working in acute and subacute settings were analyzed. There was a lack of national practice documents to guide dysphagia clinical training and service provision, and services were generally guided by internal documents. Despite this, dysphagia services were similar across acute and subacute settings. However, differences between settings were identified in screening and instrumental assessments services, perceived rehabilitation intensity, perceived rehabilitation adherence among patients, and extent of challenges with onward referrals. Whilst Singapore’s dysphagia services were largely aligned with other countries, challenges unique to the Singapore context was found relating to enteral feeding management, language barrier, financing framework, and care transitions. These findings build on the knowledge of dysphagia practices internationally, and provide direction for service optimization in Singapore.