Implementing Dysphagia Screening and Assessment in an Intermediate and Long-Stay Hospital: A Hospital-Based Quality Improvement Project

Abstract

Dysphagia can occur due to a wide range of medical conditions including acute or progressive neurological disorders, trauma or surgery, with secondary effects such as dehydration and malnutrition causing an increase in morbidity and mortality rates. Dysphagia screening and assessment of swallowing function by a multidisciplinary care team is essential to identify, diagnose and manage patients with dysphagia. A cross-sectional study of dysphagia screening and assessment was performed from the 1st to the 15th of April 2022 on patients hospitalised in an intermediate and long-stay hospital in Cartagena in the southeast of Spain. The Eating Assessment Tool-10 (EAT-10) questionnaire was used as a direct-scoring screening test for dysphagia together with the standardised Volume-Viscosity Swallow Test (V-VST) in all patients with an EAT-10 score ≥ 3 points. After confirming dysphagia, different dietary and pharmaceutical interventions were performed. The following data were collected from the medical record program EKON®: age, gender, primary diagnosis, diet and texture and the use of thickener for liquids. A total of 86 patients were included in the study with a mean age of 80.0 ± 12.0 years. The mean EAT-10 score was 2.5 ± 1.7 points with 36 patients (43.9%) testing positive for being at risk of presenting dysphagia. Of these patients at risk, the V-VST detected dysphagia and the necessity of a nectar consistency in 24 patients, a honey consistency in 3 patients and a pudding consistency in 2 patients. Only 10 of the patients with dysphagia were using thickener prior to the screening and the assessment. Dietary and pharmaceutical interventions were made in the other 19 patients with dysphagia. Dysphagia screening in intermediate and long-stay hospitals is not common practice even though there is a high prevalence and important clinical repercussions. Implementing dysphagia screening and assessment protocols will improve quality of care in these patients.