Establishing a clinical care pathway to expedite rehabilitation transitions for stroke patients with dysphagia and enteral feeding needs

Abstract

Objective Evaluate the safety and efficacy of a physiatrist-led clinical pathway to expedite rehabilitation transitions for stroke patients with dysphagia requiring nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). Design Retrospective single-center observational study in 426 adults with stroke and dysphagia admitted to the acute hospital. PM&R was consulted to determine dysphagia prognosis and candidacy for rehabilitation admission with NGT or PEG. The proportion of patients accepted with NGT vs. PEG, progression to total oral diet during rehabilitation, and lengths of stay were tracked. Results The rate of recovery to total oral diet for patients accepted with NGT was 38/44 = 86.3% vs. 29/75 = 38.6% with PEG. There was a significant difference in mean time to total oral diet with NGT (20.37 days) vs. PEG (34.46 days): t (43) = 4.49, p < .001. The acute hospital length of stay was significantly shorter with NGT (12.9 days) vs. PEG (20.4 days): t (117) = 4.16, p < .001. Rehabilitation length of stay did not differ significantly between groups (26.9 vs. 32.0 days). Conclusion Physiatrist-led initiatives to evaluate stroke patients with dysphagia can expedite rehabilitation transitions, prevent-unnecessary invasive procedures and reduce acute hospital length of stay.