Accessing Swallow Imaging Evaluations in the Community: A Cross-Sectional Survey of Speech-Language Pathologists

Purpose: Access to imaging evaluations of swallowing are essential for accurate diagnosis and treatment planning in dysphagia management. This initial survey study investigated access to imaging assessments of swallowing (i.e., modified barium swallow studies [MBSS] or fiberoptic endoscopic evaluations of swallowing [FEES]) for speech-language pathologists (SLPs) working in nonhospital-based settings in the United States. The survey aimed to (a) determine if practitioners in nonhospital care settings experience difficulty accessing imaging evaluations of swallowing, (b) identify if access to imaging evaluations has a perceived negative impact on patient care from the practitioner's perspective, and (c) explore potential barriers to access. Method: A web-based cross-sectional survey was distributed to SLPs in October 2023. Respondents who reported practicing in settings without onsite access to MBSS or FEES were included. The survey consisted of fixed-response and open-ended items addressing access, timeliness, barriers, and perceived risks to patient care. Results: Of 184 total respondents, 70 (38%) SLPs reported no direct access to imaging assessments, with most working in skilled nursing or long-term care facilities. While 68% ( n = 48/70) reported confidence in ultimately securing an evaluation when needed, only 33% ( n = 23/70) reported timely access. More than half ( n = 43/70, 61%) experienced difficulty obtaining imaging evaluations, and 78% ( n = 54/69) perceived this as placing patients at risk of harm. Open-ended responses identified barriers related to scheduling, transportation, interdepartmental dynamics, and gatekeeping by other providers. Conclusions: Findings from this initial survey suggest that SLPs in community-based settings report barriers to timely access to swallowing imaging evaluations, despite their clinical necessity. Findings underscore the need for identifying local and system-level specific barriers to reduce delays and enhance dysphagia care delivery outside hospital settings.