[Dysphagia] MBS protocol thoughts

[lovdatsoap at gmail.com (donna w)]

For a  number of years I did MBS's in 3 hospitals( this was 17+ years
ago)   Each one would have the Radiologist and SLP in the room
discussing events as they occured  and modifying if we needed more
info  and at times there would be a pleasant disagreement about
whether or not aspiration occured esp if it was in small amount and
when it went to Digital images  many of those  questions never arose
because the image was so much better
  I had a radiology tech deliver the material in 2 of the 3 hospitals
because I feel I  really do miss a lot when I  "serve and duck"
The MD and I would view  & discuss and write as we watched  I filled
out a checklist and  gave him/her the copy and we discussed issues
during the test  The radiologist would call the referring MD if signif
issues occured so it was MD to MD  It was very fast and we would do up
to 4+ back to back I cannot imagine doing a MBS without their educated
eyes esp since they had the ability to write for a esophogram and do
it  immed
 I still feel that  it would only degrade the test if  I omitted the
physicians eyes  but that is just me and my teeny view on it all  On
numerous times they have contributed invaluable insights  and raised
interesting questions
MDs are  insightful and over time the teamwork developes  into a optimal event

 I was lucky to have supportive administrators but we did educate them
frequently

We were lucky enough to be able to follow pts from ICU/Interm
care/acute SNF or rehab and then OP so we learned that the super brief
MBS missed enough to be problematic and we added serial gulps and food
which made it more realistic and caught more events We got faster over
time
  It has been a while since I was in a place that did 15 a week and
now I only do a few a year since I am on Sundays only  so I missed out
on the budget crunch and how it impacted MBS delivery  My current
acute care still uses both MD and SLP and only rarely do I have the
luxury of a tech around to deliver material but I miss it
 The longest portion of the test was the followup afterwards with pt
family ed and signs and diet recs  Some MDs allowed us to write the
diet order and they would sign it off so that made it faster and some
docs needed the phone discussion with us
later to hash out the final "package" Some docs didnt want us to
discuss the results with patients and others absolutely wanted us to
deal  with it all

I find it interesting how the MBS  has so many faces in different
places  Some have a "type" of pt and it impacts the style of the test
( ie young TBI's  vs a place with mostly nursing home OP referrals  vs
 a large acute care with primarily fresh CVA's)

We did a flow sheet once on what could happen wrong in the time  flow
of a MBS and it was so funny how many places it would derail   We
laughed
donna