Think stroke before you choke: Increasing dysphagia screening compliance in the emergency department
Recommended Citation
Cruz K, Shefferly B, Kuehni AL, et al. Think stroke before you choke: Increasing dysphagia screening compliance in the emergency department. Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background: Dysphagia in the stroke population can lead to serious complications including aspiration pneumonia, increased length of stay, and increased mortality. Early dysphagia screening and identification can help prevent these complications.
Local Problem: A Midwest community hospital identified an opportunity to improve dysphagia screening compliance in patients undergoing a stroke evaluation. Despite initial attempts to increase screening from July to December 2022, rates remained below target at 82.8% in the Emergency Department (ED). During the same timeframe, the aspiration pneumonia rate in stroke patients was 2.6%. Data analysis revealed most fallouts occurred in patients > 65 years who had received a non-contrast head computed tomography (CT).
Method: In January 2023, an interdisciplinary work group was assembled and initiated a Plan, Do, Study, Act (PDSA) process improvement project. The overall aim was to increase compliance in screening for dysphagia all patients diagnosed with a stroke prior to oral administration of food, water, or medication. Steps taken included implementing dysphagia screening on patients > 65 who also received a non-contrast head CT scan, adding screening results to the ED to inpatient electronic report in the electronic health record, and collaborating with physicians to evaluate and revise the patient’s plan of care. Process change information was disseminated to staff through standard communication, e-mails, and shift huddles.
Results/Conclusions: There was 100% dysphagia screening compliance in the target population during PDSA cycles in February and March 2023. There were zero cases of aspiration pneumonia in the stroke patient population. The process was formally adopted in March 2023. An unanticipated finding was identification of non-stroke patients with possible dysphagia who benefitted from additional consults and diet modification.
Implications for Practice: 346 patients screened during the test period increased ED RN workloads by approximately 5 minutes per patient.
Document Type
Poster
Publication Date
11-15-2023
Think stroke before you choke: Increasing dysphagia screening compliance in the emergency department
Background: Dysphagia in the stroke population can lead to serious complications including aspiration pneumonia, increased length of stay, and increased mortality. Early dysphagia screening and identification can help prevent these complications.
Local Problem: A Midwest community hospital identified an opportunity to improve dysphagia screening compliance in patients undergoing a stroke evaluation. Despite initial attempts to increase screening from July to December 2022, rates remained below target at 82.8% in the Emergency Department (ED). During the same timeframe, the aspiration pneumonia rate in stroke patients was 2.6%. Data analysis revealed most fallouts occurred in patients > 65 years who had received a non-contrast head computed tomography (CT).
Method: In January 2023, an interdisciplinary work group was assembled and initiated a Plan, Do, Study, Act (PDSA) process improvement project. The overall aim was to increase compliance in screening for dysphagia all patients diagnosed with a stroke prior to oral administration of food, water, or medication. Steps taken included implementing dysphagia screening on patients > 65 who also received a non-contrast head CT scan, adding screening results to the ED to inpatient electronic report in the electronic health record, and collaborating with physicians to evaluate and revise the patient’s plan of care. Process change information was disseminated to staff through standard communication, e-mails, and shift huddles.
Results/Conclusions: There was 100% dysphagia screening compliance in the target population during PDSA cycles in February and March 2023. There were zero cases of aspiration pneumonia in the stroke patient population. The process was formally adopted in March 2023. An unanticipated finding was identification of non-stroke patients with possible dysphagia who benefitted from additional consults and diet modification.
Implications for Practice: 346 patients screened during the test period increased ED RN workloads by approximately 5 minutes per patient.
Affiliations
Aurora West Allis Medical Center