Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke

Authors

W Lee Titsworth, From the Department of Neurosurgery (W.L.T.), Department of Nursing and Patient Services, Shands Hospital (J.A., J.H., P.G.), Speech, Language, and Hearing Sciences (A.F.), Department of Neurology (M.F.W.), and Department of Neuroscience (M.F.W.), University of Florida, Gainesville, FL; Department of Neurosurgery, Vanderbilt University, Nashville, TN (J.M.); and Harvard School of Public Health, Boston, MA (W.L.T.).
Justine Abram
Amy Fullerton
Jeannette Hester
Peggy Guin
Michael F. Waters
J Mocco

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: Dysphagia can lead to pneumonia and subsequent death after acute stroke. However, no prospective study has demonstrated reduced pneumonia prevalence after implementation of a dysphagia screen. METHODS: We performed a single-center prospective interrupted time series trial of a quality initiative to improve dysphagia screening. Subjects included all patients with ischemic or hemorrhagic stroke admitted to our institution over 42 months with a 31-month (n=1686) preintervention and an 11-month (n=648) postintervention period. The intervention consisted of a dysphagia protocol with a nurse-administered bedside dysphagia screen and a reflexive rapid clinical swallow evaluation by a speech pathologist. RESULTS: The dysphagia initiative increased the percentage of patients with stroke screened from 39.3% to 74.2% (P<0.001). Furthermore, this initiative coincided with a drop in hospital-acquired pneumonia from 6.5% to 2.8% among patients with stroke (P<0.001). Patients admitted postinitiative had 57% lower odds of pneumonia, after controlling for multiple confounds (odds ratio=0.43; confidence interval, 0.255-0.711; P=0.0011). The best predictors of pneumonia were stroke type (P<0.0001), oral intake status (P<0.0001), dysphagia screening status (P=0.0037), and hospitalization before the beginning of the quality improvement initiative (P=0.0449). CONCLUSIONS: A quality improvement initiative using a nurse-administered bedside screen with rapid bedside swallow evaluation by a speech pathologist improves screening compliance and correlates with decreased prevalence of pneumonia among patients with stroke.

Keywords

cerebral hemorrhage, dysphagia, ischemic stroke, pneumonia, quality initiative, screening, subarachnoid hemorrhage

Medical Subject Headings

Aged; Brain Ischemia (complications, therapy); Cross Infection (epidemiology, prevention & control); Deglutition; Deglutition Disorders (diagnosis); Female; Humans; Intracranial Hemorrhages (complications, therapy); Male; Mass Screening (methods); Middle Aged; Odds Ratio; Pneumonia (epidemiology, prevention & control); Prevalence; Prospective Studies; Quality of Health Care; Stroke (complications, therapy); Surveys and Questionnaires

Publication Date

11-1-2013

Publication Title

Stroke

E-ISSN

1524-4628

Volume

44

Issue

11

First Page

3154

Last Page

60

PubMed ID

23963330

Digital Object Identifier (DOI)

10.1161/STROKEAHA.111.000204

Recommended Citation

Titsworth, W Lee; Abram, Justine; Fullerton, Amy; Hester, Jeannette; Guin, Peggy; Waters, Michael F.; and Mocco, J, "Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke" (2013). Translational Neuroscience. 1332.
https://scholar.barrowneuro.org/neurobiology/1332