Four-hour swallow screening target for stroke – from guidelines to practice: A mixed methods knowledge translation study

Abstract

Purpose: To conduct systematic analysis of compliance with swallow screening against a 4-hour target timeframe and determine barriers and facilitators to compliance. Method: Knowledge translation approach using mixed methods. Quantitative data from a medium sized metropolitan hospital was extracted from 12-months of medical records to review timing of swallow screening from stroke admission using descriptive and inferential statistics. Qualitative data involved 14 semi-structured interviews of speech-language pathologists, registered nurses and medical officers and were analysed using the Theoretical Domains Framework. Result: 74% of eligible patients (271/365) received a swallow screen by trained nursing staff; 189 (52%) were within the 4-hour target. Screening was facilitated by quality training of nurses, strong belief in the benefits for patients and availability of the specialist stroke nurse. Quantitative analysis, confirmed through participant interviews as barriers, revealed that the strongest predictors of not meeting the 4-hour target were overnight admissions and not being admitted to the dedicated stroke unit. Conclusion: 52% of swallow screenings were performed within the 4-hour target timeframe recommended as best practice in the Australian and UK stroke guidelines. Barriers identified may assist other institutions improve compliance with the 4-hour timeframe that will likely be adopted internationally.