Decision making and the bedside assessment: The Speech Language Therapists' thinking when making a diagnosis at the bed.
Kim Coutts, Mershen Pillay
PMID 34212747WHAT IT FOUND
Seven South African speech therapists relied on 'gut feelings' and experience to diagnose swallowing issues at the bedside.
Adding oxygen and sound monitoring to standard checks gave them more data and confidence. They often trusted their own assessment over inaccurate nursing notes.
Key findings
01Therapists reported that adding cervical auscultation and pulse oximetry to the clinical swallow evaluation provided three to four data sets instead of one or two, which improved their confidence in making bedside decisions.
02Experienced therapists were more likely to trust their clinical instincts and diagnose subtle penetration, whereas junior therapists relied more on procedural knowledge and external discussion.
03Therapists frequently found multidisciplinary team input, particularly from nursing staff, to be inaccurate regarding patient tolerance, leading them to rely primarily on their own bedside assessments.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included only seven therapists, all female, from a single public hospital in South Africa, limiting the generalizability of the findings to other contexts or demographics. The data were collected before the COVID-19 pandemic, so the specific pressures and changes in practice during the pandemic are not reflected. The study describes the process of decision-making and the factors therapists *said* they used; it does not validate whether these bedside diagnoses were accurate compared to gold-standard instrumental measures for these specific patients. Convenience sampling was used, which may introduce selection bias.
Declared interests
The text does not explicitly state a conflict of interest declaration, but notes the study stemmed from a doctoral thesis and was conducted in a public sector hospital.
The easy way to misread this
Do not interpret the therapists' increased confidence or reliance on 'gut feelings' as evidence that bedside assessment is as accurate as instrumental measures like VFSS or FEES. The study reports on the *process* of decision-making and the *subjective* experience of the therapists, not on the objective accuracy of their diagnoses.