• W Lee Titsworth, Justine Abram, Amy Fullerton, Jeannette Hester, Peggy Guin, Michael F Waters, and J Mocco.
• 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.).
• Stroke. 2013 Nov 1; 44 (11): 3154-60.

Background And PurposeDysphagia 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.MethodsWe 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.ResultsThe 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).ConclusionsA 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.

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