Access to Videofluoroscopic Swallow Studies Across Clinical Settings in the United States and Canada: A Survey Study

Purpose: Videofluoroscopic swallowing studies (VFSSs) are critical for diagnosing and managing dysphagia, yet access varies widely across clinical settings. Delayed access may contribute to poor outcomes, including aspiration-related complications. This study aimed to document rates of on-site VFSS access, characterize access barriers, and describe perceived consequences of delays among speech-language pathologists (SLPs) in the United States and Canada. Method: A cross-sectional online survey was distributed over 2 months to SLPs managing patients with dysphagia. Quantitative and qualitative data were collected. Descriptive statistics summarized quantitative responses; thematic analysis was applied to open-ended responses. Results: A total of 344 SLPs responded. Among those using VFSS ( n = 312), 73% reported on-site access. Access was highest in acute care (91%) but markedly lower in skilled nursing (18%) and home health (11%). Rural clinicians reported lower access (63%) and longer wait times. While nearly half of acute care respondents reported VFSS access within 1–2 days, 16% of subacute respondents reported wait times exceeding 1 month. The most frequently cited barriers were limited appointment availability (64%) and transportation logistics (32%), with additional themes from open-ended responses including staffing shortages (36%) and restrictive administrative policies (26%). Nearly 40% of respondents believed delayed access placed patients at risk, and only 20% felt confident making diet recommendations without imaging data. Conclusions: SLPs across settings face appreciable barriers to timely VFSS access, with the greatest limitations in subacute and rural care environments. These findings underscore a critical gap in dysphagia care and the need for systemic solutions, including enhanced infrastructure, staffing, and interdisciplinary collaboration, to ensure equitable access to imaging evaluations of swallowing.