Flexible Endoscopic Evaluation of Swallowing (FEES) has become one of the most valuable tools in dysphagia assessment. While physicians may be most associated with endoscopic procedures, speech-language pathologists (SLPs) hold a central role in FEES, guiding the process from assessment to treatment planning. The SLP’s role in FEES extends beyond technical expertise—it shapes patient outcomes and influences how the procedure is integrated across skilled nursing facilities (SNFs), hospitals, and outpatient clinics.
The SLP’s Role in FEES and Scope of Practice in Dysphagia Assessment
According to the ASHA Practice Portal on Adult Dysphagia, SLPs are the preferred providers of dysphagia services, responsible for both clinical and instrumental assessments. This includes interpreting FEES results, identifying swallowing impairments, and creating individualized treatment plans. ASHA’s Scope of Practice in Speech-Language Pathology further clarifies that SLPs may conduct and interpret instrumental swallowing assessments such as FEES. At Diagnostech, our mobile FEES services are designed to empower SLPs to fulfill this role seamlessly within hospital and SNF settings.
Training and Certification Requirements for Performing FEES
Unlike some procedures that require board certification, FEES does not mandate specialty certification through ASHA. However, competency is essential. The ASHA FEES competency resources emphasize that clinicians must demonstrate proficiency through structured training. Most SLPs gain expertise through programs which combine didactic instruction, hands-on practice, and supervised clinical experience. Diagnostech supports this professional development through our FEES training and education programs, ensuring SLPs are confident and compliant when implementing FEES.
Collaboration with Physicians During FEES
While SLPs may lead the assessment, collaboration with physicians is integral to safe and effective FEES practice. Otolaryngologists, gastroenterologists, and radiologists may be involved in establishing protocols or supporting higher-risk cases. Research on collaborating physician structures and costs notes that agreements can vary depending on risk, specialty, and regulatory environment. At Diagnostech, our collaborative care model connects SLPs with medical partners so that FEES implementation is both clinically sound and operationally efficient.
We incorporate objective assessment tools, including the Reflux Index Scale, which has demonstrated up to 95% predictive accuracy for laryngopharyngeal reflux disease (LPRD). These measures provide physicians with critical diagnostic insight to optimize medical management.
Translating Findings into Treatment
The true value of FEES lies in how its findings shape treatment. Common findings such as aspiration, penetration, or pharyngeal residue, as described in clinical swallowing assessment literature, directly inform treatment planning. SLPs may recommend diet modifications, compensatory strategies, or targeted rehabilitative exercises. FEES also provides a powerful tool for biofeedback and treatment monitoring, allowing patients to see their swallowing mechanics in real time. Diagnostech’s mobile FEES evaluations make it possible to capture these insights at the point of care, leading to faster, evidence-based treatment decisions.
Advocacy for FEES in SNF and Hospital Settings
Despite its clinical value, FEES is not yet universally available in all care settings. Advocacy from SLPs is driving change, particularly in SNFs and hospitals where access to instrumental swallowing evaluations can be limited. Resources such as the ASHA guide to advocating for access to instrumentation highlight FEES’ advantages: portability, cost-effectiveness, and reimbursement potential. By partnering with administrators and care teams, SLPs can expand access to FEES. Diagnostech works closely with facilities to support policy adoption and advocacy, helping providers integrate FEES into their dysphagia management protocols.
The role of SLPs in FEES extends far beyond operating the scope. They bring together clinical expertise, interdisciplinary collaboration, and patient-centered advocacy to ensure dysphagia care is accurate, accessible, and effective. As more facilities adopt FEES, the leadership of SLPs will continue to shape both practice standards and patient outcomes.
To learn more about implementing FEES in your hospital or SNF, explore our Diagnostech FEES services.
