Recognizing dysphagia: implementation of an in-hospital screening protocol
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ORIGINAL ARTICLE
Recognizing dysphagia: implementation of an in-hospital screening protocol Isabel Taveira 1
&
Serafim Silva 1 & Íris Bonança 1 & Daniela Parreira 1 & Célia Antunes 1
Received: 10 March 2020 / Accepted: 17 September 2020 # Royal Academy of Medicine in Ireland 2020
Abstract 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. Keywords Aspiration . Deglutition . Dysphagia . Hospital . Risk assessment . Screening
Introduction Dysphagia is one of the most commons symptoms in older adults, affecting up to 30% of hospitalized patients [1]. Dysphagia, by itself, regardless of the cause of in-hospital admission, is associated with a number of complications, such as malnutrition, dehydration, aspiration pneumonia, longer length of hospital stay (LOS), discharge to nursing home and higher mortality [2–4]. Early identification of swallowing problems is crucial, given the significant clinical impact for the patient and the prohibitive financial costs associated with the complications of dysphagia [5]. The literature shows that dysphagia affects at least 25% of all * Isabel Taveira [email protected] 1
Litoral Alentejano Hospital, Monte do Gilbardinho, Estrada Reg 261, 7540-230 Santiago do Cacém, Portugal
in-hospital admitte
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