Recognizing dysphagia: implementation of an in-hospital screening protocol.

Background: Dysphagia affects up to 30% of hospitalized patients, and it is associated with numerous complications.
Aims: Assess the impact of a 24/7 dysphagia screening protocol in an Internal Medicine Unit regarding respiratory complications (such as aspiration pneumonia) as the primary outcome. Length of stay and discharge destination were secondary outcomes.
Methods: Case-control hospital-based analysis comparing the outcomes before and after the implementation of the screening protocol. We analysed demographic data (such as age and gender) and clinical data (presence of dysphagia, vascular risk factors and other comorbidities, respiratory complications, in hospital length of stay and discharge destination). Patients with at least one of the following risk factors were included: COPD (chronic obstructive pulmonary disease), neurodegenerative disorders including dementia, acute stroke or chronic cerebrovascular disease, head and neck neoplasms/surgery or radiotherapy. Statistical analysis was performed with SPSS®.
Results: One hundred twenty-eight consecutive patient files were reviewed as the historical control, while 125 consecutive patients were evaluated after the screening protocol was implemented. Even though the second group had less evidence of dysphagia (33 vs 36), since it was detected earlier, respiratory complications were significantly lower (11.7% before vs 2.4%, p < 0.001), allowing more patients to be discharged home (65.6% vs 84%, p = 0.005) and less mortality (15.6% vs 4%, p = 0.005).
Conclusions: Despite its limitations, this study demonstrates that dysphagia screening produces a significant impact on patients' lives, as well as healthcare professionals and resources. We hope that our results will encourage others to adopt a patient-centred multidisciplinary approach that includes a dysphagia screening protocol.