A Practical Guide to SLP Screens

Do I need to evaluate every admission to my SNF?

No. You may want to screen every admission, but you do not need to complete a full evaluation unless there is justified concern regarding swallowing, cognition, language, voice, etc. A screen is a brief assessment to determine if further SLP evaluation is warranted. It typically takes about 5 to 10 minutes.

Who should be screened?

New admissions, hospital readmissions (patient went out to the hospital & came back), and patients with a change in status are some common reasons to screen someone.

What do I ask in a screen?

Dysphagia screens: The goal of a dysphagia screen is to ask questions about swallow and cough function, and if there are any reported signs or symptoms of dysphagia, then a full SLP evaluation may be warranted. To keep it simple, you could choose to administer the EAT-10.

Cognitive screens: Again, the goal of a cognitive communication screen is to determine if further SLP evaluation is warranted. Common practice is an informal interview. However, using a standardized measure such as the Mini Mental State Examination (MMSE) can make the screen more objective so you are not guessing if they need further evaluation or not.

When should I skip screening?

Sometimes it is appropriate to skip screening and move directly to a full evaluation. Some reasons you may move directly to a full evaluation include new coughing during meals, an acute neurological change, a skilled admission admitted on a modified diet, diet texture downgrade by nursing staff, recurrent pneumonia, a physician order specifically requesting an evaluation, or patient/caregiver reports new communication, cognitive, or swallowing concerns.

Important reminders

• Remember, standardized screens support, but do not replace, clinical judgment. A resident may “pass” a screen yet still require evaluation based on observed signs, medical history, or interdisciplinary concerns.

• It is not uncommon for a resident in a nursing home to be an unreliable reporter due to cognitive communication deficits. Always use your clinical judgement and include family, caregivers, or nursing staff in your screen for reliable information when necessary.

• Screens do not diagnose or establish a plan of care. They only indicate whether further evaluation is warranted.

• Finally, passing a screen does not mean “never evaluate.” Patients can develop swallowing or cognitive deficits after admission or after your initial screen. If new concerns arise, a screen can be repeated or a full evaluation completed, even if the initial screen was unremarkable.