Standardized Measures for Bedside Dysphagia Evaluations

Bedside swallow evaluations are most effective when they combine clinical expertise with standardized, evidence-based assessment tools. Incorporating measures such as the ones discussed in this article can help clinicians gather objective data on patient-reported symptoms, oral health, aspiration risk, and swallowing. These tools add consistency to evaluations, support clinical decision-making, and help track changes in swallowing function over time. They can also provide objective evidence to support recommendations for instrumental assessment, as well as the need for diet modifications when clinically indicated. While no single tool can diagnose dysphagia on its own, using multiple standardized measures provides a more comprehensive picture of the patient’s swallowing status and can strengthen both assessment and documentation.

EAT - 10

The EAT-10 is a patient-reported outcome measure that objectively tracks changes (negative or positive) in someone’s swallowing by asking them to rate signs and symptoms of oropharyngeal dysphagia on a scale from 0 to 4.

In the skilled nursing facility setting, however, many patients have cognitive-communication impairments that limit their insight into swallowing difficulties or their ability to complete the questionnaire independently. In these cases, obtaining information from a caregiver can be extremely valuable. Family members, nursing assistants, or other caregivers who regularly observe the patient during meals may be able to provide meaningful responses that better reflect the patient’s swallowing function.

Additionally, some individuals with cognitive deficits can successfully complete the EAT-10 when questions are read aloud and appropriate support is provided. As with any assessment tool, clinicians should consider the patient’s cognitive abilities and interpret results within the context of the overall clinical picture.

Oral Health Assessment Tool (OHAT)

We know oral health is an important factor in oropharyngeal dysphagia but how do we report oral health other than “good’ and “poor”? This tool helps you assess dentition, tissue integrity, saliva, and more. You can administer this tool repeatedly in order to track changes in oral health.

Test of Mastication and Swallowing Solids (TOMASS)

This tool is really great for assessment of mastication. Terms such as “prolonged mastication” can be subjective and may be interpreted differently across clinicians. The TOMASS uses saltines, which are typically easy to find in a SNF, and has norms based on age for you to directly compare and see how your patient’s mastication and swallowing compares to their peers.

Yale Swallow Protocol (YSP)

The Yale Swallow Protocol (YSP) has demonstrated high sensitivity (95.4%) in post-acute care settings, making it an effective screening tool for identifying patients who may benefit from further swallowing assessment (Ward et al., 2020).

However, it is important to understand the limitations of the YSP. A pass or fail result does not confirm whether a patient is aspirating, as penetration and aspiration cannot be definitively identified through a bedside swallow screening alone. Likewise, passing or failing the YSP does not automatically indicate the presence or absence of dysphagia.

As with any screening tool, YSP results should be interpreted within the context of the patient’s overall clinical presentation. Clinical decision-making should incorporate findings from the entire evaluation, including medical history, current status, patient symptoms, observations during assessment, and any additional diagnostic information available.