February 2009 Newsletter

Consultants in Dysphagia Evaluation and Management

817-514-MBS1 or 1-888-514-MBS1
February 2009
Happy Valentines Day!
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator
Love is patient, Love is Kind!
I expect to pass through this world but once, any good I can do, or any love and kindness I can show, let me do it now, for I shall not pass this way again.

Please keep them in your thoughts and prayers With her permission, I wanted to share with you that one of our Speech Pathologist colleagues in the DFW area, Amy Richards, is going through a very difficult time.  Her 4 year daughter, Reagan, has been unexpectedly diagnosed with an aggressive brain tumor, a Stage IV glioblastoma.  Not only as Speech Pathologist do we understand the diagnosis, but we are even more touched as most of us know how we would feel if our own children or family member were given such a devastating diagnosis. There are many prayers and wishes going up for Amy, Reagan, and her family.  We have taken the steps to refer Reagan to the North Texas Make a Wish as well as setting up a community fund to help with expenses.  Amy would like to also encourage everyone to consider donating to the St. Jude CA fund. Your donation makes a real difference. Eighty-five cents of every dollar received supports the research and treatment at St. Jude Children’s Research Hospital. You can call St. Jude at 800-805-5856 or go to www.stjude.org.  If you would like to learn more about the community fund, please contact DiagnosTEX and we will provide you with that information. Please keep them in your prayers.

Nature of Mobile MBSS Service. Having the availability of mobile provides a convenience of avoiding a trip to the hospital and a radiology waiting room in a chair or on a gurney, which Dr. Suess calls the “Waiting Place”. J.  Having a mobile service also requires flexibility as we are subject to being delayed due to traffic or construction, cancellations and refusals, involved family member’s present, behavioral patients or a vomiting episodes, patients not ready and out of bed when we arrive or even unexpected add-ons.  We give an approximate appt. time for your patient, but being aware that it is subject to change, as this is the nature of doing mobile studies/service.  Please advise you patients, families and facility staff we make a 100% heartfelt effort to arrive on the scheduled time, but by being mobile many things can happen during our day traveling to so many facilities across the Metroplex with interactions with so many individuals, that it may require that an appt. time to be adjusted earlier or later. We will always notify you as soon as we know our estimated time of arrival. 

Also please understand there is no possible way for us to run this mobile business and get to all of the pending studies in a timely manner if we allowed everyone requesting a study to request a specific time period or day for their studies to be done. We schedule and group our studies based on geographical areas. This is necessary and allows us to operate this business efficiency and effectively, as well as being cost efficient with all the health care costs and cuts of this era. Often low caseloads and with the economy, some SLP’s are not staying as late or not getting to work as early.  We have a lot of other issues to work around (dialysis, families, physician credentialing etc.) and can not always accommodate everyone’s work schedule, staff meeting, personal appts., etc.   We currently do many studies without the SLP present. We understand everyone would like to be present to see their patient’s study done. But if the study is necessary and we can only schedule it in when we are the in the area, you may need to consider allowing us to do it anyway or take the risk of being delayed a few more days before we are in the area again.  The reason physician do not make house calls anymore is because Medicare and health care system has made this financially difficult to come to the patient, but our service continues to allow this, in a sense.  The Mobile allows convenience for the population we service, of not having to leave the facility or the home. If you need a specific day and specific time, you may need to consider making an appt. at a hospital. 

DiagnosTEX covers over 200 facilities in the DFW and surrounding area, there is no way to remember what facilities have limitations such as “ No Fridays”, so please remember to write this on your History form when you fax in a request and be aware this may delay your study into the following mid week.
Upcoming FEB conference on E-Stim I have had many inquiries about the next E-Stim conference:  Saturday February 28, 2009, 7.5 TSHA CEU”S  – San Antonio, TX Texas  Professional Imaging LLC is a Mobile MBSS company in East Texas, Houston, Austin, and San Antonio, not a part of DiagnosTEX, LLC.  They have invited us as a guest speaker, please call their Corp office 1-866-675-MBSS to register or for any questions about the conference. Limited seating

Self feed during an MBSS – I have had some recent requests for patients to self feed.  We do often and like to encourage the patient to self administer cup sips and straw sips if capable, as this will no doubt involve increased bolus size and head flexion based on an assisted cup sip. The DiagnosTEX SLP will evaluate the patients behavior and before and during the initial part of the study to determine the patients appropriateness for self feeding and will decide the course of action.  Us DiagnosTEX SLP’s do not like wearing the food we feed nor do we like cleaning up the floor! There are several reasons we do not allow or encourage spoon feeding on more cohesive boluses and they include the following: 1) depending on the pt. size, self feeding with a spoon  will lift the shoulders and obstruct the full view of the pharynx and VC which is necessary for us to evaluate during the entire study. 2) when a patient uses a spoon, they typically tend to feed and lean forward toward the cup, often placing them out of position.  Positioning is one of the most important factors to an adequate study and once in a good position, we do not want to jeopardize this. 3) We also like to control the bolus size from small to large, whatever is appropriate and whatever we need to assess for functionality, strategies, or safety. 4) usually when a patient is self feeding, they often want to hand the cup and spoon to us immediately afterwards, no matter what we have requested of them, and this requires us to take our eyes off the monitor and this is also something that we can not do during this evaluation.  Therefore, please understand we will allow self feeding of cup sips when appropriate, but the majority of the time the DiagnosTEX SLP’s will administer all food boluses to provide you with a quality study on all levels.

Dysphagia Tidbit – Liability
Recommended Book
Case Studies in Dysphagia Malpractice Litigation
Dennis C. Tanner, Ph.D.
109 pages. Softcover. 6 x 9 in
ISBN 10: 1-59756-325-0. ISBN 13: 978-1-59756-325-3.
US $59.95 CAN $68.00 £38.00 AU $94.00  This book can be ordered at Plural Publishing.
ABOUT THE BOOK  – Drawing on his experiences as an Expert Witness in numerous medico-legal cases, Dennis Tanner provides an overview of dysphagia and reviews issues that may lead to malpractice litigation.  The first part of the book he provides a general overview of the anatomy, physiology, and neurology of sucking, chewing, and swallowing. The three stages of swallowing are detailed including objectives, methods, and procedures of evaluation and treatment. In the second part, he addresses the primary issues in dysphagia malpractice litigation including professional proficiency in dysphagia management, professional communication, the clinical bedside assessment and instrumental swallowing studies, and diet and feeding considerations. Part III comprises a review of dysphagia malpractice litigation issues and the role of the expert witness, and the concluding part provides a comprehensive analysis of five dysphagia malpractice cases and reviews the issues from the plaintiff and defense positions. All five dysphagia cases involve the deaths of the dysphagic patient.

Required Paperwork  As much as I know how healthcare professionals hate paperwork, it is necessary on many levels.  DiagnosTEX is not excluded from this.  We require 3-4 pieces of documentation to schedule an MBSS, without them we will not provide the service. Medicare regulations and others require us to get much more strict on these items in 2009. If these are completed in their entirety when they are faxed in, the office staff will not have to track you down prior to scheduling youRpatient.  We need all paperwork which includes history form and authorization form completed in its entirety. On the history form, please provide ALL information on the patient, including first and last name of referring physician. The authorization form is a form allowing us to do the MBSS and to bill for the service we are providing your patients and therefore must be completed in its entirety by you and the patient. ALL bullets MUST BE initialed by the responsible party acknowledging understanding and acceptance or else we will not complete the study.
For example, below is sample of the bottom of the page:

Patients name:         PATIENTS NAME MUST BE FILLED IN ON THIS LINE                  
Date:        DATE MUST BE FILLED IN                      

Signature must be obtained prior to the MBSS

Witness signature required if individual is unable to sign independently
Witnesses must be employed by the facility
Witness:  MUST BE SIGNED ONLY IF WITNESSING THE PATIENTS MARK ABOVE                                         
Preferably DON or administrative staff, if unavailable, nursing staff may sign


If the patient is unable to sign but is able to give verbal consent or the family is contacted and gives verbal consent to perform the MBSS and also acknowledges financial responsibility as stated in the bullet areas (so be sure they understand each one of them), then the area seen below must be completed with date, name, relationship of the person/persons giving consent. The signature of the staff person receiving consent IS REQUIRED.

If received verbal consent only, please document in medical chart and sign below

Date received:                                         DATE MUST BE FILLED IN                                                                                 
Staff Signature                          STAFF PERSON RECEIVING CONSENT MUST PROVIDE SIGNATURE HERE             
Thank you all of you who are putting the first and last name of the doctor on the history forms! This is helping us a lot!