title: Safe initiation of oral diets in hospitalized patients based on passing a 3-ounce (90 cc) water swallow challenge protocol.
abstract: BACKGROUND
  Safe and timely oral alimentation is crucial for optimum patient care.
  
  
  OBJECTIVE
  To determine the short-term success of recommending specific oral diets, including drinking thin liquids, to acute care hospitalized patients at risk for dysphagia based on passing a 3-ounce water swallow challenge protocol.
  
  
  METHODS
  Prospective single group consecutively referred case series.
  
  
  METHODS
  Large, urban, tertiary care, teaching hospital.
  
  
  METHODS
  1000 hospitalized patients.
  
  
  METHODS
  3-ounce (90 cc) water swallow challenge protocol.
  
  
  METHODS
  Specific diet recommendations and volume (in cc) of liquid ingested at the next day's meal 12-24 h after passing a 3-ounce challenge protocol were accessed electronically from oral intake information entered on each participant's daily care logs. Eating and drinking success, clinically evident aspiration events and compliance with ordering the recommended diet were recorded. Care providers were blinded to the study's purpose.
  
  
  RESULTS
  Of 1000 patients, 907 met the inclusion criteria of stable medical, surgical or neurological conditions 12-24 h after passing a 3-ounce water swallow challenge protocol. All 907 were both eating and drinking thin liquids successfully and without overt signs of dysphagia. Median volume of liquid ingested was 340 cc [interquartile range (IQR), 240-460]. Specific diet recommendations were followed with 100% accuracy.
  
  
  CONCLUSIONS
  A 3-ounce water swallow challenge protocol successfully identified patients who can be safely advanced to an oral diet without subsequent identification of overt signs of aspiration within 12-24 h of testing. Importantly, when a clinical 3-ounce challenge protocol administered by a trained provider is passed, specific diet recommendations, including drinking thin liquids, can be made safely and without the need for additional instrumental dysphagia testing.
authors: Yale University School of Medicine, Department of Surgery, Section of Otolaryngology, PO Box 208041, New Haven, CT 06520-8041, USA. steven.leder@yale.edu
authors: S B
authors: SB
authors: Leder
authors: D M
authors: DM
authors: Suiter
authors: H L
authors: HL
authors: Warner
authors: L M
authors: LM
authors: Acton
authors: M D
authors: MD
authors: Siegel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D004032:Diet; D004326:Drinking; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014867:Water
chemical_list: D014867:Water