Dysphagia screening after acute stroke: a quality improvement project using criteria-based clinical audit

Abstract

Background: D ysphagia is common afte r stroke and represents a major risk factor for developing aspiratio n pneum onia. Earl y detection can reduce the risk of pulmonary complications and death. Despite the fact that evide nce-based guidelines reco mmend screening for swallowing deficit using a standardized scr eening tool, n ational audits has identified a gap between practice and this recommendation. The aim was to determine the l evel of adherence to an evid ence-based r ec om mendation on sw al low assessment and to tak e actions to i mprove practice if necessary. M ethods: We carried out a criteria-base d clinical audit (CBCA) in a small stroke unit at a Norwegian hospital. Patients with hemorrhagic stroke, isch emic stroke and transient ischemic attack were included. A power calcu lation informed the number of included patient s at baseline (n = 80) and at r e-audit (n = 35). We compare d the baseline result with the evidenc e-based criteria and gave feedback t o management and st aff. A brainstorming session, a root–cause ana lysis and implementation science were used to in form the quality imp rovement actions which consisted of workshop s, us e of local o pinio n leaders, manual paper reminders and feedback. We completed a re-audit after implementat ion. Percentages and median are reported with 95% confiden ce intervals (CI). Results : Among 88 cases at baseli ne, documentati on of swa llow screening was com plete f or 6% (95% CI 2–11). In the re-audit (n = 51) 61% (95 % CI 45–74) had a complete screening . Conclusion: A CBCA in volvi ng managem ent and staff, an d using multiple tailored in terventi on targeting barriers, led to greater adherence with the recomm endation for screening stro ke patients for dysphagia.