Improving dysphagia screening in acute stroke

Aim

To develop a toolkit to improve completion of dysphagia screening for acute stroke patients across services and outside of hours, towards nationally established benchmarks.

Outcomes

This project has culminated in the development of the Dysphagia Screening for Stroke toolkit accessible to all Queensland Health staff (including in metro, regional and rural settings). It houses ready-to-use but tailorable resources and strategies to address local barriers to dysphagia screening. Early feedback indicates that the toolkit contents are appropriate and relevant for clinicians, and satisfaction was high for resources to raise awareness and deliver staff education and training. We have established strategic partnerships to support dissemination and uptake of the toolkit across the state. Future evaluation is required to determine the impact of the toolkit on dysphagia screening performance.

Background

Dysphagia (swallowing disorder) affects ~42% of patients following stroke (Bray et al., 2017) and is associated with a range of complications including pneumonia, resulting in increased dependency, morbidity, hospital length of stay and mortality (Banda et al., 2022; Bray et al., 2017). National Australian stroke guidelines recommend all people with stroke undergo screening/assessment to identify risk of dysphagia/aspiration using a validated tool, by a trained professional. The Australian Clinical Stroke Registry (AuSCR) sets benchmarks for dysphagia screening/assessment. However, average statewide completion of dysphagia screening is below these established benchmarks despite substantial local effort. Additionally, there is great variation in dysphagia screening between across sites and out of hours, meaning many stroke patients do not receive this important intervention and may be at risk of aspiration.

Discussion

This initiative developed a change management toolkit to support improvements to dysphagia screening in Queensland Health hospitals, particularly within our emergency departments. We developed a suite of ready-to-go but tailorable resources for improvement, mapped to commonly reported barriers to dysphagia screening.

Strategies and resources include ward signage and visual reminders about dysphagia screening, education and training solutions, a proposed pathway for dysphagia screening, and guidance on measuring change in accordance with the RE-AIM framework (Glasgow et al., 1999). The toolkit is now available to all Queensland Health clinicians with dissemination supported via strategic partnerships.

References

1. Banda, K. J., Chu, H., Kang, X. L., Liu, D., Pien, L.-C., Jen, H.-J., Hsiao, S.-T. S., & Chou, K.-R. (2022). Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC geriatrics, 22(1), 420-410. https://doi.org/10.1186/s12877-022-02960-5
2. Bray, B. D., Smith, C. J., Cloud, G. C., Enderby, P., James, M., Paley, L., Tyrrell, P. J., Wolfe, C. D. A., & Rudd, A. G. (2017). The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of neurology, neurosurgery and psychiatry, 88(1), 25-30. https://doi.org/10.1136/jnnp-2016-313356
3. Feldstein, A. C., & Glasgow, R. E. (2008). A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf, 34(4), 228-243. https://doi.org/10.1016/s1553-7250(08)34030-6
4. Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health