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Surprisingly Easy to Swallow

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Science Translational Medicine  04 Sep 2013:
Vol. 5, Issue 201, pp. 201ec145
DOI: 10.1126/scitranslmed.3007369

Despite aggressive medical and surgical interventions, stroke remains a devastating disease with significant morbidity and mortality. Many clinicians suggest that the most effective treatment is passive: observation and the tincture of time. Titsworth and colleagues would disagree. In a recent study, the group reports the results of an initiative to improve dysphagia (difficulty swallowing) screening in acute stroke patients admitted to a large, tertiary care medical center.

Titsworth et al. conducted a single-center prospective interrupted time series trial to test the effects of implementation of a dysphagia-assessment protocol composed of a nurse-administered bedside screen and a reflexive rapid clinical swallow evaluation by a speech pathologist. The investigators enrolled 2334 patients with ischemic or hemorrhagic stroke admitted to their institution over a 42-month interval and assessed the impact of the protocol on institutional screening compliance and prevalence of hospital-acquired pneumonia. The study was divided into a 31-month (n = 1686 patients) preintervention and an 11-month (n = 648 patients) postintervention period. The relation between quarterly dysphagia screening percentage and pneumonia prevalence was assessed with Pearson product moment correlation. Logistic regression analysis with pneumonia as the primary outcome controlled for relevant confounders. The dysphagia initiative increased the percentage of stroke patients screened from 39.3 to 74.2% (P < 0.001). Furthermore, initiative implementation was associated with a decrease in hospital-acquired pneumonia from 6.5 to 2.8% of acute stroke patients (P < 0.001).

Many acute stroke treatments focus on opening blocked blood vessels or protecting “at risk” brain tissue. Titsworth et al. implemented a straightforward screening protocol that aims to decrease the incidence of in-hospital pneumonia in a high-risk patient group. Although this study may lack the “home run” appeal of many current therapeutic trials, it succeeds where others have failed: demonstrating a tangible improvement in patient outcomes. As quality-assessment measures gain increased importance in health care delivery, standardized initiatives such as this one will be critical in achieving and benchmarking improved patients outcomes.

W. L. Titsworth et al., Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke. Stroke, published online 20 August 2013 (STROKEAHA.111.000204). [Abstract]

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