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Background: Dysphagia occurs in up to 78% of stroke patients and is associated with poor patient outcomes. We have previously reported low concordance rates between dysphagia screens performed by neuroscience bedside nurses compared with Speech Language Pathologists (SLPs) using the 3oz water test. Hypothesis: A multidisciplinary intervention can improve concordance rates of dysphagia screening between bedside nurses and SLPs and reduce aspiration pneumonia rates among stroke patients. Methods: An interdisciplinary team including stroke quality nurses, clinical nurse specialists, SLPs, and nursing informatics developed a 3-step intervention including 1) modifications of the electronic dysphagia screen forms to simplify documentation and provide step-by-step instructions for nursing staff, 2) hospital-wide re-education to nurses on performing dysphagia screens and 3) adjustment of all stroke ordersets to include prechecked NPO orders to prevent diet orders prior to a dysphagia screen. Interventions were completed by August 31, 2016. All stroke patients admitted to a Comprehensive Stroke Center from March 1, 2016 to May 31, 2017 were included in this analysis to determine aspiration pneumonia rates pre- and post-intervention (N=988). To determine concordance rates in dysphagia screening, neuroscience nurses and SLPs performed the same screen on consecutive stroke patients within <24 hours of each other; concordance rates were compared before and after study intervention. Results: Overall aspiration pneumonia rates significantly declined after the intervention from 11.8% to 7.3% (p=0.03). Significant declines in aspiration pneumonia rates after intervention were seen in ischemic stroke (10.4% vs 4.3%, p=0.02) patients but not seen in intracranial hemorrhage (14.8% vs 10.1%, p=0.41) or subarachnoid hemorrhage patients (11.5% vs 10.1%, p=0.85). Concordance rates between nurses and SLPs significantly increased from 52% pre-intervention up to 73% post-intervention (p=0.04). Conclusion: Our 3-step multidisciplinary dysphagia screening intervention significantly reduced aspiration pneumonia rates among ischemic stroke patients and improved concordance rates in screening results among neuroscience nurses and SLPs.

Background: While there is recognition about the importance of dysphagia screens in stroke patients, there is limited data on the concordance rates of dysphagia screens performed by neuroscience-trained nurses and speech language pathologist (SLPs). Hypothesis: Neuroscience nurses and SLPs will have high concordance rates when assessing stroke patients with dysphagia screens. Methods: From March 1, 2016 through May 31, 2016 a random sample of stroke patients underwent a dysphagia screening by neuroscience nurses and subsequently by SLPs within 24 hours using the same tool, a 2-part screen assessing for contraindications and using the 3-ounse water swallow test. Results of the dysphagia screens were retrospectively collected to identify concordance rates. Results: During the study period, 98% of stroke patients underwent dysphagia screening prior to oral intake. Of 50 stroke patients evaluated by neuroscience nurses and SLPs, only 26 patients (52%) demonstrated concordance with pass or fail results. Of 33 patients who were administered the water test and passed the dysphagia screen based on the neuroscience nursing assessment, 20 patients (61%) were determined by SLPs evaluation to have dysphagia and 11 (33%) of these patients had had overt aspiration. Conclusions: Current metrics on dysphagia screening do not identify the efficacy of dysphagia screening among stroke patients. Stroke centers who utilize bedside nurses to perform initial dysphagia screens should evaluate concordance rates with SLPs. A multidisciplinary team including Clinical Nurse Specialists, SLPs, and Nursing IT specialists have implemented measures (hospital wide re-education of nursing staff and optimizing the electronic dysphagia screening form) to improve concordance rates among nurses and SLPs. A post-intervention follow-up study of concordance rates among neurosciences and SLPs is underway.