Abstract T P339: Plan-Do-Study-Act Model Has Positive Impact on Dysphagia Screening in the Emergency Room

Abstract

Background: Dysphagia is a serious complication of stroke, which can cause aspiration pneumonia leading to increased length of stay or death. Baptist Medical Center (BMC) is one of five Primary Stroke Center Certified hospitals in the Baptist Health System (BHS). In October 2013 it was noted that BMC dysphagia screen measure results had trended downward to be the lowest in the system. Purpose: The purpose of this abstract is to outline actions taken to address the documentation of the dysphagia screen in the emergency room (ER) at BMC. Methods: An analysis of BMC’s dysphagia screen fall outs revealed four contributing factors for this quality measure including: no screen completed (34%), oral intake prior to the screen (38%), a delay in stroke diagnosis 22%) or incomplete documentation (6%). Initially the dysphagia screen was completed on paper while the rest of the ER documentation was completed in the electronic medical record (EMR). In October a performance improvement effort was implemented using a Plan-Do-Study-Act Model (PDSA). Initial changes included placing dysphagia screening forms in each room for easier access, 1:1 teaching with staff for fall outs, and designating a nurse Stroke Champion. Inconsistent improvement was seen so dysphasia documentation was add to the EMR, a patient complaint list was developed and attached to each computer, and any patient with a Head CT order was automatically screened. In April, the directors started assigning a dysphagia screen education module to any staff member with 2 or more fallouts. The PDSA graph and action plan was posted in the ER and discussed during monthly staff meetings. Results: Dysphagia screen documentation in stroke patients in the ER at BMC improved from a low of 73.7% in October 2013 to 100% in May 2014. The drop in April 2014 to 88.5% was attributed to leadership changes and staff turnover. Conclusion: A focus on dysphagia improved the screening of stroke patients in the ER. The commitment to 1:1 teaching and further education emphasized the importance of screening. Dysphagia screening results will continue to be monitored, posted, and discussed monthly.