Abstract
Background: While there is recognition about the importance of dysphagia screens in stroke patients, there is limited data on the concordance rates of dysphagia screens performed by neuroscience-trained nurses and speech language pathologist (SLPs). Hypothesis: Neuroscience nurses and SLPs will have high concordance rates when assessing stroke patients with dysphagia screens. Methods: From March 1, 2016 through May 31, 2016 a random sample of stroke patients underwent a dysphagia screening by neuroscience nurses and subsequently by SLPs within 24 hours using the same tool, a 2-part screen assessing for contraindications and using the 3-ounse water swallow test. Results of the dysphagia screens were retrospectively collected to identify concordance rates. Results: During the study period, 98% of stroke patients underwent dysphagia screening prior to oral intake. Of 50 stroke patients evaluated by neuroscience nurses and SLPs, only 26 patients (52%) demonstrated concordance with pass or fail results. Of 33 patients who were administered the water test and passed the dysphagia screen based on the neuroscience nursing assessment, 20 patients (61%) were determined by SLPs evaluation to have dysphagia and 11 (33%) of these patients had had overt aspiration. Conclusions: Current metrics on dysphagia screening do not identify the efficacy of dysphagia screening among stroke patients. Stroke centers who utilize bedside nurses to perform initial dysphagia screens should evaluate concordance rates with SLPs. A multidisciplinary team including Clinical Nurse Specialists, SLPs, and Nursing IT specialists have implemented measures (hospital wide re-education of nursing staff and optimizing the electronic dysphagia screening form) to improve concordance rates among nurses and SLPs. A post-intervention follow-up study of concordance rates among neurosciences and SLPs is underway.
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