A useful dysphagia referral explains what has changed, what has been observed and how the concern is affecting the person’s eating, drinking, health or daily life.
Include the person’s details, the reason for referral, relevant health information, current mealtime recommendations, communication needs, consent arrangements and the best people to contact.
Describe what was seen or reported rather than trying to diagnose the problem. Clear, specific information helps the speech pathologist understand the concern, determine the next step and prepare for the assessment.
What is a dysphagia referral?
Dysphagia means difficulty swallowing. A dysphagia referral is a request for a speech pathologist to assess or review a person’s swallowing and mealtime needs.
A referral may be made because:
new swallowing signs have been observed
the person’s health or function has changed
an existing plan is no longer clear or practical
the person is having difficulty with certain food or drinks
meals are becoming longer or more tiring
food or fluid intake has reduced
current recommendations need review
carers or staff require clearer mealtime guidance
the person has returned home after hospitalisation
an updated mealtime management plan is required
A referral does not need to contain a diagnosis of dysphagia. It needs to explain the concern clearly enough for the service to determine an appropriate response.
Start with the person’s identifying details
Include accurate and current information such as:
full name
date of birth
address
telephone number
email address, where appropriate
preferred language
communication needs
relevant service or participant number, if required
current living arrangement
main contact person
relationship or role of the main contact
details of the person authorised to make or support relevant decisions, where applicable
Check that names, telephone numbers and email addresses are correct. Missing or incorrect contact information can delay the referral.
Explain the reason for referral
State the main concern near the beginning of the referral.
For example:
“Coughing a lot when drinking since returning from hospital.”
“Meals now take more than an hour and the person becomes increasingly fatigued.”
“Current mealtime management plan is outdated and does not reflect the person’s present support needs.”
“Staff have observed food remaining in the person’s mouth after meals.”
“The person reports that food feels stuck when swallowing.”
“Repeated refusal of the prescribed texture-modified meals.”
“Review requested following a recent stroke.”
“Support team requires clear recommendations for eating and drinking in the community.”
Avoid referrals that only say “swallowing assessment required” or “possible dysphagia”. Explain why the assessment is being requested.
Describe observations rather than conclusions
Report what was seen, heard or communicated.
Relevant observations may include:
coughing during or after eating and drinking
choking episodes
throat-clearing during meals
a wet, gurgly or changed voice
difficulty starting a swallow
food remaining in the mouth
difficulty chewing
food or drink spilling from the mouth
pain when swallowing
food feeling stuck
difficulty managing saliva
breathlessness or distress during meals
meals taking longer than usual
increased fatigue while eating
reduced food or fluid intake
refusal of particular foods or drinks
new dependence on assistance
difficulty taking medication
unexplained weight loss
dehydration concerns
repeated respiratory illness
a noticeable change from the person’s usual eating and drinking
These observations may have several possible causes. They do not, by themselves, confirm dysphagia or determine the appropriate food texture or drink thickness.
Include when and where the concern occurs
Context can help identify patterns and determine what should be assessed.
Include:
when the concern began
whether the change was sudden or gradual
how often it occurs
whether it is becoming more frequent
which food, drinks or medication are involved
whether it occurs at the beginning or end of a meal
whether it is more noticeable when the person is tired
the person’s position when it happens
the type of assistance being provided
whether it occurs at home, in the community or across settings
whether different staff observe the same concern
what happened immediately before and after the event
For example, “sometimes coughs with drinks” is less informative than:
“Over the past week, staff have observed coughing after several sips of water at breakfast on four occasions. This appears more frequent when the person is tired.”
Explain what has changed
A comparison with the person’s usual presentation is valuable.
Describe changes in:
eating and drinking ability
coughing or other swallowing signs
alertness
breathing
strength and mobility
posture
cognition
communication
behaviour at meals
appetite
food and fluid intake
weight
level of assistance
meal duration
food or drink preferences
ability to follow the existing plan
Include any recent event that may be relevant, such as:
stroke or neurological change
respiratory illness
surgery
hospital admission
intubation
fall or injury
significant physical deconditioning
dental changes
medication changes
progression of an existing condition
Do not assume that the event caused dysphagia. Simply provide the information so the speech pathologist can consider it during assessment.
Include relevant health information
Provide relevant diagnoses and health history where authorised and available.
This might include:
neurological conditions
respiratory conditions
head and neck conditions
gastrointestinal conditions
cognitive impairment
developmental disability
previous stroke
previous swallowing difficulties
previous aspiration or choking concerns
recent infections
dental or oral health concerns
allergies
nutrition or hydration concerns
recent surgery or hospitalisation
Include current medication information when it may be relevant or when requested by the service. A current medication list is more useful than relying on memory.
The purpose is not to send every medical document available. Include information that helps explain the referral and the person’s current circumstances.
Describe what the person currently eats and drinks
State the person’s present food, drink and mealtime arrangements as clearly as possible.
Include:
their current food texture
their current drink thickness
whether IDDSI levels are documented
foods or drinks they avoid
how medication is currently taken
utensils, cups or equipment used
positioning
assistance or supervision
pacing or prompting
where meals usually occur
who prepares the food and drinks
whether the person follows the plan consistently
any approved alternatives
If there is no current mealtime management plan, say so clearly. Describe what is currently happening without creating new clinical recommendations yourself.
Attach the current mealtime management plan
Where authorised, attach relevant documents such as:
the current mealtime management plan
previous speech pathology assessment reports
recent hospital discharge summaries
relevant medical reports
current medication list
nutrition or weight records
recent dietitian recommendations
relevant incident reports
food or fluid charts, if available
previous instrumental swallowing assessment reports
Check that the documents belong to the correct person and that the current plan is clearly identified.
Do not assume the receiving speech pathologist has access to records held by another hospital, organisation or provider.
Include the person’s communication needs
The speech pathologist needs to know how the person understands information and communicates choices, symptoms and consent.
Include:
preferred language
whether an interpreter is required
how the person communicates
whether they use signs, pictures or a communication device
how they indicate “yes”, “no”, “stop” or discomfort
hearing or vision needs
whether extra processing time is required
whether a familiar communication partner should attend
any strategies that support successful communication
Do not describe someone as “non-verbal” and leave it there. Explain how they communicate.
Include consent and decision-making arrangements
State whether the person knows about and agrees to the referral where applicable.
Also include relevant information about:
who can provide consent
whether the person requires decision-making support
an appointed decision-maker or guardian, where relevant
who should be included in discussions
who is authorised to receive reports
any limits on information sharing
Do not assume that a family member, support worker or service manager can automatically consent or receive clinical information.
Follow the person’s documented arrangements, applicable requirements and organisational procedures.
Explain the person’s goals and preferences
A swallowing assessment should consider more than symptoms.
Include what matters to the person, such as:
eating favourite or culturally important foods
drinking more comfortably
remaining as independent as possible
participating in family meals
eating at cafés or community activities
reducing the length or effort of meals
reviewing a texture-modified diet
improving the range or appeal of available meals
receiving clearer support from staff
understanding their swallowing recommendations
If the person disagrees with or dislikes their current recommendations, include this respectfully. Do not simply describe them as refusing or non-compliant.
Describe the current support environment
The assessment and recommendations need to work in the person’s everyday environment.
Include relevant details about:
where the person lives
who provides mealtime support
staff availability
kitchen arrangements
food preparation responsibilities
access to equipment
community participation
changes between weekday and weekend support
involvement of family members
day programs, respite or other settings
staff training needs
practical problems following the existing plan
This information can help the speech pathologist prepare recommendations that are clear and usable.
Indicate urgency clearly
Do not write only “urgent”. Explain why the referral may require prompt attention.
Include:
what changed
when it changed
how quickly it is progressing
its effect on food or fluid intake
any associated health changes
recent medical events
whether the current plan can still be followed
whether the person is experiencing pain or distress
what clinical advice has already been sought
The speech pathology service will consider the information and its own triage process.
A routine referral is not an emergency response.
Seek urgent medical assistance if the person experiences acute breathing difficulty, severe choking or airway obstruction, sudden neurological changes, reduced responsiveness, severe distress or another medical emergency.
State who should receive the outcome
Include the names and contact details of the people or services authorised to receive the assessment outcome.
This may include:
the person
a family member or informal carer
an appointed decision-maker
the referring health professional
the general practitioner
a service manager or coordinator
the nursing team
a dietitian
another relevant provider
Clarify who should arrange the appointment, attend the assessment and coordinate implementation of any recommendations.
What information is most helpful from carers and staff?
Carers and support staff often observe the person across many meals. Their specific observations can be extremely useful.
Helpful information includes:
the food or drink involved
what staff observed
what the person communicated
how often it occurs
time of day
fatigue
position
assistance provided
how long the meal lasted
how much the person ate or drank
whether the event differed from the person’s usual presentation
what happened afterwards
Use objective language.
Instead of writing:
“The person is unsafe when drinking.”
Write:
“The person coughed after several sips of water at lunch on three occasions this week. Staff also noticed a wet-sounding voice after one of these meals.”
Should an EAT-10 score be included?
An EAT-10 result may provide useful supplementary information when the tool has been completed appropriately.
However, it does not replace:
a clear description of the concern
relevant health information
the person’s own report
observations from carers or staff
a clinical swallowing assessment
Include the date, score and who completed it. Do not treat the result as a diagnosis or use it to independently determine food or drink recommendations.
Dysphagia referral checklist
Before submitting the referral, check that it includes:
the person’s identifying and contact details
the main reason for referral
specific swallowing or mealtime observations
when the concern began
frequency and context
recent health changes or hospital admissions
relevant diagnoses
current food texture and drink thickness
current assistance and supervision
communication and interpreter needs
consent and decision-making arrangements
the person’s goals and preferences
relevant documents
urgency and the reason for it
the best contact for arranging the assessment
who is authorised to receive the outcome
Frequently asked questions
Is a doctor’s referral required?
Requirements depend on the speech pathology service, funding pathway and organisation. Contact the service to confirm what is required. Even when a formal medical referral is not required, relevant medical information can still be valuable.
Can a family member make a referral?
A family member may be able to enquire or initiate a referral, depending on the person’s consent, decision-making arrangements, funding and the service’s requirements.
How should urgency be described?
State what changed, when it changed, how it affects the person and any relevant medical events. Give more info than only “urgent”. Emergencies require emergency medical assistance rather than a routine referral.
What if there is no current mealtime management plan?
Say so in the referral. Describe what the person currently eats and drinks, how they are supported and what concerns have been observed. Do not create new swallowing recommendations yourself.
Should the entire medical file be attached?
Usually, a focused selection of current, relevant information is more useful. Include documents that explain the swallowing concern, recent health changes and present recommendations. Ask the service if you are unsure.
What to do next
A clear dysphagia referral can help the speech pathologist understand the person’s needs and prepare for an appropriate assessment.
Swallowing & Dysphagia Support provides swallowing assessments, mealtime management plans and reviews for people experiencing swallowing difficulties.
Contact Swallowing & Dysphagia Support to discuss a referral and confirm the information required for the person’s circumstances.
Important information
This article provides general education. It cannot diagnose dysphagia, determine referral urgency or establish an individual’s food texture, drink thickness, suitability for oral intake, treatment, assistance, supervision or level of risk.
Follow local referral and emergency procedures. Do not change a person’s swallowing recommendations based on this article.
About the author
Written for Swallowing & Dysphagia Support and reviewed by Vanessa Chan, Speech Pathologist.
