Background and Issues: Stroke is the leading cause of dysphagia with 42% to 67% of patients presenting with dysphagia within 3 days. Patients admitted to Fisher-Titus Medical Center with stroke-like symptoms were often missed for dysphagia screening or given oral medication prior to a screening. After investigation, it was discovered that the screening process and the electronic medical record (EMR) were too lengthy, hard to remember to complete, and not mandatory fields. The purpose of this initiative was to leverage the EMR to improve staff compliance rates to Healthcare Facilities Accreditation Program (HFAP) stroke accreditation standards of dysphagia screening for TIA and ischemic stroke patients.
Methods: A multidisciplinary team was formed to analyze factors contributing to missed dysphagia screenings. The team then modified the EMR to make it more lean and effective. Changes to the EMR included: addition of a mandatory “Risk Factors for Stroke” check box targeting vague stroke symptoms; auto-population of the dysphagia screen form when a “risk factor” was selected; and implementation of a rapid screen format. Dysphagia screening rates were monitored over 16 quarters.
Results: The purpose of the initiative to improve the EMR, streamline the screening process, and increase staff compliance rates of dysphagia screening to HFAP standard of >85%. This goal was met. Prior to the changes in the EMR, compliance rates in 2011 were inconsistent and significantly below threshold. The multidisciplinary team was formed in Q1 2012, began changes in the EMR Q3 2012, and concluded changes in Q1 2014. Since conclusion of EMR revisions the threshold has been consistently exceeded.
Conclusions: Our data suggests that optimizing the use and functionality of EMR formats improve compliance rates of dysphagia screenings. In our sample, after completion of EMR changes compliance rate averaged 96%. Other institutions who wish to improve compliance rates of dysphagia screenings (and potentially other clinical standards) should consider evaluating their current EMR format, delineating its strengths/weaknesses by interviewing team members, and revising to optimize compliance.