The Yale Swallow Protocol is a standardized swallowing screen developed by Debra Suiter and Steven Leder.
In this post, you’ll find a step-by-step guide to the protocol, who to use it with, plus a free PDF!
Please note that all information and materials in this post are intended for speech-language pathology professionals working with adult patients.
For our bestselling, evidence-based patient handouts and worksheets, check out the Adult Speech Therapy Starter Pack!
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What Is The Yale Swallow Protocol?
The Yale Swallow Protocol is a swallowing screen that’s been validated by research for many patient populations and settings.
The purpose of a swallowing screen is to determine if dysphagia is likely and if a comprehensive swallowing assessment (and/or referral out) is needed.
Swallowing screens are also quicker, easier, and cheaper than a full speech therapy assessment.
Another bonus is that hospitals with mandatory swallowing screens have been shown to have lower pneumonia rates.
The Yale Swallow Protocol is pass/fail and has 3 parts:
- Brief cognitive screen
- Brief oral mechanism examination
- 3-ounce water test (slightly modified from the original)
How To Do The Yale Swallow Protocol
1. Exclusion Criteria: Yale Swallow Protocol
Before starting the Yale Swallow Protocol, the therapist must answer ‘NO’ to all of the following:
- Unable to remain alert for testing
- On a modified diet due to pre-existing dysphagia
- Tube feeding in place
- Head of bed restrictions <30 degrees
- Tracheostomy tube present
- NPO by physician order
2. Cognitive Screen: Yale Swallow Protocol
Orientation Questions:
- What’s your name?
- Where are you right now?
- What year is it?
Follow Commands:
- Open your mouth
- Stick out your tongue
- Smile
How to Use the Cognitive Screen
The researchers found that patients not oriented by three had a 31% greater risk of aspiration. And patients unable to follow commands had a 57% greater risk of aspiration.
While the cognitive screen gathers useful information, it does NOT exclude the patient from finishing the screen.
3. Oral Mechanism Exam: Yale Swallow Protocol
- Labial closure
- Lingual range of motion
- Facial symmetry (smile/pucker)
How to Use the Oral Mech Screen
The researchers found that patients with decreased lingual range of motion had a 2.72-time increased risk of aspiration.
While the oral mech screen gathers useful information, it does NOT exclude the patient from finishing the screen.
4. 3-Ounce Water Swallow Challenge
What to do:
- Sit the patient upright at 80-90 degrees (or as tolerated, as long as it’s more than 30 degrees)
- Ask the patient to drink an entire 3 ounces (90cc) of water in sequential swallows, slow and steady without stopping
The patient fails if:
- They pause (even briefly) while drinking the 3 ounces
- They cough or choke during or immediately after drinking the 3 ounces
If they fail, refer to speech therapy for a comprehensive swallowing assessment.
More tips:
- Stand to the side of the patient to watch their throat while swallowing (to better identify pauses)
- Either a cup or straw is fine. Held by the patient or therapist/other is also fine
- It’s okay to repeat the 3-ounce water swallow challenge if it seems that the patient would pass with a second attempt
Who To Use The Yale Swallow Protocol With?
The developers of the Yale Swallow Protocol found that the 3-ounce water swallow test is an effective swallowing screen for the following diagnostic categories:
- Cardiothoracic surgery
- Esophageal surgery
- Head and neck surgery
- Neurosurgery
- Pulmonary
- Cancer
- Left stroke
- Right stroke
- Brain stem stroke
- Parkinson’s disease
- Dementia
- Medical
For patients post-extubation, the Yale Swallow Protocol is an accurate swallowing screen at one hour, four hours, eight hours, and the day after extubation. However, the researchers caution that accuracy drops the longer the patient was intubated.
Who NOT To Use The Yale Swallow Protocol With?
The Yale Swallow Protocol is not recommended for:
- Patients with tracheostomy tubes
- Patients with head and neck cancer who have undergone radiation
Yale Swallow Protocol PDF!
More Resources
References
- Suiter, D. (n.d.) The Yale Swallow Protocol: When, How, and Why Use It (Recorded Webinar). Medbridge. medbridge.com/courses/details/yale-swallow-protocol-when-how-and-why-to-use-it-recorded-webinar-debra-suiter