Authors (including presenting author) :
Wong AYH(1), Cheung, AYH(1), Cheng, VHM(1), Wong, RK(2),Chan TC(3)
Affiliation :
(1) Speech therapy department, TWGHs Fung Yiu King Hospital (2) Speech therapy department, Queen Mary Hospital (3) Department of Medicine, TWGHs Fung Yiu King Hospital
Introduction :
Besides Videofluoroscopic Swallowing Study (VFSS), Flexible Endoscopic Evaluation of Swallowing (FEES) is also a beneficial first line instrumental examination for assessing dysphagia patients without using ionizing radiation (Helliwell, et al., 2023). It not only allows direct visualization of movements of larynx, pharynx and vocal cords, but also rules out silent aspiration. It also evaluates the effectiveness of swallowing maneuvers during swallow (Ambika, et al., 2019). TWGHs Fung Yiu King Hospital (FYKH) has no fluoroscopic unit. Patients requiring instrumental swallowing examination must be transferred to Queen Mary Hospital (QMH) for VFSS with NEATS. The inter-hospital transfer for examination not only causes discomfort to the frail elderly, but also delays patient management.
Objectives :
To evaluate the outcome of ST-led bedside Flexible Endoscopic Evaluation of Swallowing (FEES) for geriatric patients in convalescence hospital (FYKH) in HKWC
Methodology :
ST-led bedside FEES was first introduced to FYKH in late June 2024 and it was the first convalescence hospital to start ST-led bedside FEES in medically frail elderly patients in Hong Kong. Forty-six ST-led bedside endoscopic examination was carried out in medical wards in FYKH from late June to March 2025.
Result & Outcome :
All the endoscopic procedures were done without any complication. Two were aborted as patients were not cooperative. 43.2% of the patients, who were kept nil by mouth or on Ryles tube feeding, resumed oral feeding after the instrumental examination while 11.4% of the patients had their diets upgraded. Aspiration and penetration were identified in the remaining 45.4% of the patients. The average waiting time for each bedside FEES was around 2.7 days, which significantly shortened the waiting time by 2.5 times (i.e. 7 days) when compared to the old practice. A Mann-Whitney U test revealed a statistically significant difference in waiting time between the FEES group and the VFSS group (U = 110.5, Z = -2.96, p= 0.003). In addition, patient escort was not required and the booking of NEATS was significantly minimized and the quota could be saved for those who were in need within cluster.
To conclude, the newly developed ST-led bedside FEES service in FYKH enhanced patients’ safety by providing timely instrumental examinations to dysphagia patients to identify aspiration risks on oral feeding. Without patient transfer, the new service also shortened the waiting queue for instrumental examination, and promoted earlier resumption of oral feeding, resulted in shorter length of stay.
