Triaging dysphagia: nurse screening for dysphagia in an acute hospital

Authors

  • Julie AY Cichero,

    1. Authors:Julie AY Cichero, BA, BSpThy (Hons), PhD, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Sarah Heaton, BSpPath, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Lynell Bassett, BSpThy, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia
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  • Sarah Heaton,

    1. Authors:Julie AY Cichero, BA, BSpThy (Hons), PhD, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Sarah Heaton, BSpPath, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Lynell Bassett, BSpThy, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia
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  • Lynell Bassett

    1. Authors:Julie AY Cichero, BA, BSpThy (Hons), PhD, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Sarah Heaton, BSpPath, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia; Lynell Bassett, BSpThy, Speech Pathologist, Speech Pathology Department, Royal Brisbane and Womens Hospital, Herston, Qld, Australia
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Julie AY Cichero, Speech Pathology Department, Royal Brisbane and Womens Hospital, Butterfield Street, Herston, Qld 4006, Australia. Telephone: +61 7 3870 4561.
E-mail:j.cichero@uq.edu.au

Abstract

Aims and objectives.  To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme.

Background.  Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse-screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse-administered, evidence-based swallow screening tool for generic acute hospital use.

Design.  Prospective, quasi-experimental.

Methods.  Nurses were assessed for knowledge pre- and post-training. All patients were nurse-screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test.

Results.  Thirty-eight nurses participated in a seven-week study; 442 patients were screened on two general medical wards. Three speech pathologists counter-assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3·4% of clinical screening decisions were incorrect. Compliance rate was 85%.

Conclusions.  Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening.

Relevance to clinical practice.  Twenty-five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women’s Hospital dysphagia screening tool. Patients are triaged into categories of ‘those requiring additional specialist intervention’ and ‘those who can proceed directly to regular diets and liquids’. Improved quality of care and cost savings is likely.

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