Prospective Quality Initiative to Maximize Dysphagia Screening Reduces Hospital-Acquired Pneumonia Prevalence in Patients With Stroke

Background and Purpose— 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 P P =0.0011). The best predictors of pneumonia were stroke type ( P P 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.