title: Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke.
abstract: OBJECTIVE
  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.
authors: 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.).
authors: W Lee
authors: WL
authors: Titsworth
authors: Justine
authors: J
authors: Abram
authors: Amy
authors: A
authors: Fullerton
authors: Jeannette
authors: J
authors: Hester
authors: Peggy
authors: P
authors: Guin
authors: Michael F
authors: MF
authors: Waters
authors: J
authors: J
authors: Mocco
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000628:therapy; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care; D020521:Stroke / Q000150:complications* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: cerebral hemorrhage; dysphagia; ischemic stroke; pneumonia; quality initiative; screening; subarachnoid hemorrhage