Optimizing Dysphagia Treatment Delivery in Acute Care: A Hybrid Efficacy Implementation Trial

This study will involve two in-person research evaluations in the hospital that will last 45 minutes- 1 hour and will consist of a screening, breathing and cough testing, swallow function testing, measures of frailty, and completion of questionnaires. Following the initial research evaluation, critically ill adults will complete the intervention they are assigned to as prescribed. The exercises will take 15-20 minutes to complete and adherence to treatment will be tracked. Prior to hospital discharge and after completion of the intervention, critically ill adults will undergo a second research evaluation.

Clinical speech-language pathologists will complete questionnaires about the interventions that will take 10-15 minutes.

A subset of critically ill adults and clinical speech-language pathologists will also have the opportunity to participate in focus groups, which will take 45 minutes-1 hour.

Inclusion criteria

for critically ill adults will be:

• Adult ≥ 18 years old
• Not pregnant
• Underwent a clinical flexible endoscopic evaluation of swallowing (FEES) or videofluoroscopy swallow study (VFSS) with a penetration aspiration scale (PAS) score ≥ 5
• Hospitalized in non-neuro intensive care unit (ICU) setting at Vanderbilt University Medical Center (VUMC) at some point during admission
• Dysphagia is primarily related to ICU stay and not other medical conditions that may cause dysphagia
• medically cleared with no contraindications for expiratory muscle strength training (EMST) or other treatments
• Cognitive capacity to follow basic directions
• Willing to undergo testing and treatment for the study.

Inclusion criteria

for speech-language pathologists (SLPs) will be:

• Adult acute care speech-language pathologist who works at VUMC.
• Willing to complete surveys and/or participate in a focus group.