Background: Bedside dysphagia screening potentially identifies 60% of patients at risk for aspiration. Potential/actual stroke patients may not be identified prior to oral medications/food. Our previous dysphagia screening was challenging to use and as a result, many stroke cases were missed.
Problem: Potential patients at risk for aspiration pneumonia were not being identified using a dysphagia screening.
Interventions: A new dysphagia screening instrument was developed by an interdisciplinary team of nurses and speech language pathologists. Pilot reliability testing of the old tool indicated a reliability of 86%, while the new tool was found to be 95% reliable. Validity testing showed that the new dysphagia screening tool predicted patients at risk for dysphagia 96% of the time, while the old instrument predicted dysphagia only 88% of stroke patients. The new dysphagia instrument was implemented in 10/2014, and is now performed for all ED patients who have a non-contrast head CT.Current real-time auditing of core measures and reporting of compliance data is now in place with accountable parties, using concurrent chart review and real-time feedback to Nurse Managers for all missed cases
Results/Conclusions: Compliance with dysphagia screening has risen from 84% in 9/2014 to 100% in 6/2015. Patients at risk for aspiration/aspiration pneumonia have been successfully identified using the new dysphagia screen and measures are implemented to prevent or treat high risk patients to improve outcomes. Most patients who developed aspiration pneumonia had been previously identified as failing the new dysphagia screen and these patients were maintained npo and placed on aspiration precautions. Mortality rates for inpatient stroke patients dropped by 73% in the 4th quarter of 2014, fostering a #1 ranking for inpatient mortality, and top 5% in overall quality for 2014 when benchmarked with other academic medical centers participating in United Health Care (UHC) rankings. The new dysphagia screening instrument and monitoring practices has dramatically improved detection of patients at risk for dysphagia/potential aspiration, and has contributed to a significantly lower rate of inpatient stroke mortality.