The Yale Swallowing Protocol is a quick, standardized screening tool designed to detect risk of aspiration in adults potentially suffering from dysphagia. Formerly known as the 3-ounce water swallow test, it has been refined at Yale University to include a brief preliminary assessment and a specific water-drinking challenge.
The protocol typically involves: (1) a cognitive screen (ensuring the patient is alert and can follow simple directions), (2) an oral mechanism exam (to check basic tongue and lip movement), and (3) having the patient drink 3 ounces (90 ml) of water continuously without stopping. If the patient completes the water swallow with no coughing, choking, or throat clearing during or shortly after, and without stopping, the screen is considered “passed." If the patient cannot finish the water or shows signs of aspiration (coughing or wet vocal quality), they “fail” the screen and should be referred for a full swallowing evaluation (such as a videofluoroscopic swallow study or FEES). Importantly, the Yale protocol is a screening, not a full assessment – it cannot diagnose dysphagia or detail its nature, but it is highly sensitive in identifying those who require further evaluation.
Suiter, D. M., & Leder, S. B. (2008). Clinical utility of the 3-ounce water swallow test. Dysphagia, 23(3), 244–250. Link
Suiter, D. M., Sloggy, J., & Leder, S. B. (2014). Validation of the Yale Swallow Protocol: A prospective double‑blinded videofluoroscopic study. Dysphagia, 29(2), 199–203. Link
