Between Necessity and Feasibility: A Qualitative Study on How Clinicians Navigate Bedside Voice Assessment.
Adrián Castillo-Allendes, Jeff Searl, Thea Knowles and 3 others
PMID 40603208WHAT IT FOUND
SLPs said acute care prioritizes swallowing over voice, so bedside voice assessment is often delayed.
They rely on listening, patient reports, phone recordings and voice tasks, with little standardized protocol, despite patient concern about voice.
Key findings
01SLPs described swallowing as taking priority over voice in acute and inpatient care, often delaying voice assessment until swallowing is stable.
02Clinicians relied mainly on auditory-perceptual listening and patient self-report for bedside voice assessment.
03Some clinicians used maximum phonation time and the S/Z ratio as bedside indicators of swallowing efficiency.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Findings are self-reported clinician practices, not observed assessment accuracy or patient outcomes. Twenty-five clinicians were interviewed, and saturation was reported at participant 19, so the sample may not represent all settings. Most participants were based in the United States (80%, n=20), and comparisons between ICU, rehabilitation and other settings were not systematically explored. The paper does not test whether any strategy improves voice assessment or patient care.
The easy way to misread this
Do not treat maximum phonation time and the S/Z ratio as validated swallowing tests based on this paper. The study reports clinician practices, and the authors note the evidence for these cross-system uses is limited.