Assessment Of Dysphagia Research Articles

A Within-Subject Comparison of Face-to-Face and Telemedicine Screening Using the Timed Water Swallow Test (TWST) and the Test of Mastication and Swallowing of Solids (TOMASS)

The Timed Water Swallow Test (TWST) and the Test of Mastication of Solids (TOMASS) are dysphagia screening procedures that have been shown to be reliably assessed from video. The reliability of the procedures performed over telemedicine has not previously been assessed. TWST and TOMASS outcomes in two situations (both face-to-face and over telemedicine) were compared for 48 participants (aged 60–90; 27 with clinical conditions and 21 older persons). Both testing situation and test performed order were randomized, and all assessment procedures were performed within 3 h of each other. The results indicated a high level of agreement between face-to-face and telemedicine screening outcomes for TWST and TOMASS, respectively. The assessments indicated an 83% and 76% agreement in classifications of individual participants as within or outside normal limits for the TWST and TOMASS for the two test situations. The TWST showed a balanced distribution in differing classification in telemedicine (0.16–0.19 error rates). The TOMASS procedure classified more participants as outside normal limits over telemedicine compared to face-to-face administration. Agreement in the observed number of swallows was substantially lower than other outcome measures, which is attributed to increased difficulty in observing this property over video. Most participants (60%) reported that they would prefer telemedicine over face-to-face assessments, and 90% viewed the procedure as more accessible than expected. All participants were satisfied with the telemedicine procedures. The results suggest that clinical assessment of dysphagia over telemedicine using the TWST and TOMASS are viable alternatives to face-to-face administration of the procedures.

Best Practice in Swallowing Assessment in COVID-19.

The COVID-19 pandemic has significantly altered the world as we know it. Service delivery for the instrumental evaluation of dysphagia in hospitalized patients has been significantly impacted. In many institutions, instrumental assessment was halted or eliminated from the clinical workflow, leaving clinicians without evidence-based gold standards to definitively evaluate swallowing function. The aim of this study was to describe the outcomes of an early, but measured return to the use of instrumental dysphagia assessment in hospitalized patients during the COVID-19 pandemic. Data was extracted via a retrospective medical record review on all patients on whom a swallowing consult was placed. Information on patient demographics, type of swallowing evaluation, and patient COVID status was recorded and analyzed. Statistics on staff COVID status were also obtained. Over the study period, a total of 4482 FEES evaluations and 758 MBS evaluations were completed. During this time, no staff members tested COVID-positive due to workplace exposure. Results strongly support the fact that a measured return to instrumental assessment of swallowing is an appropriate and reasonable clinical shift during the COVID-19 pandemic.

PROFESSIONAL PREFERENCES OF SPEECH PATHOLOGIST FOR THE ASSESSMENT AND MANAGEMENT OF DYSPHAGIA AFTER STROKE

Background: Dysphagia is common after stroke, leading to adverse outcome. The clinical decisions are often based on usual practice, however no formal or similar methods exists to determine the efficacy for assessment and treatment of dysphagia after stroke. Objective:To determine professional preferences among SLPs in terms of opted techniques and approaches for the assessment and management of dysphagia in major cities of Pakistan. Methods:Study design was cross sectional survey and data was collected from practicing speech language pathologists of Rawalpindi, Islamabad, Lahore and Karachi from July 2020 till January 2021through online medium on Google forms. The non-probability convenient sampling technique was used for data collection from speech language pathologists. Sample size was n=31 out of which n=20 were females and n=11 were males. Responses of all participants were presented in the form of n(%) through SPSS version 20. Results: There was variation between all the responses of participants from different cities of Pakistan. The Speech and language pathologists (SLPs)had access to instrumental assessment video fluoroscopy n=5 (16.1%), FEES n= 4 (12.9%) and more than one instrumental assessment tools n= 8 (25.7%) but before recommendation of exercise is rarelyn=20 (64.3%) practiced. The two principal outcome measures for direct dysphagia exercises indicated by SLPs were Oral control n=12 (35.2%) and reduced aspiration n=8 (12.9%). To measure direct exercises outcomes SLPs rarely n=25 (80.7%) uses instrumental assessment tools but use rating scales n=29 (93%). SLPs also prefer to see patient for management of dysphagia 1-2 times a day, 1-4 days a week, for 45 minutes. The most frequently preferred direct exercises are lip range movement n=15 (48.4%), lip strength n=16 (51.6%) and effortful swallow n= 16 (51.6%) whereas electrical stimulation method is least practiced n=5 (16.2%). Conclusion: The Speech language pathologists showed variability in preferences for assessments and management practices and format. Keywords:Dysphagia, clinical decision making, speech-language pathology, stroke.

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

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.

Generating Items for a Novel Bedside Dysphagia Screening Tool Post Acute Pediatric Stroke.

Bedside dysphagia assessment protocols are not well developed in acute pediatric stroke unlike adults. The objective of this study was to identify items deemed relevant and feasible by expert consensus to inform the development of a bedside dysphagia screening tool for acute pediatric stroke. A two-phase study was conducted: (1) literature review and expert consultation generated a comprehensive list of dysphagia assessment items; (2) items were formatted in an online survey asking respondents opinion of relevance to acute pediatric stroke and feasibility for bedside administration by a trained health professional. The Dillman Tailored Design approach optimized response rate. Respondents were identified using the snowball method. Speech-language pathologists with > 2years in pediatric dysphagia were invited to complete the survey. Demographic and practice variables were compared using univariate statistics. Item relevance and feasibility were made using binary or ordinal responses, combined to derive item-content validity indices (I-CVI) to guide item reduction. Items with I-CVI > 0.78 (excellent content validity) were moved forward to tool development. Of the 71 invited respondents, 57(80.3%) responded, of which 34(59.6%) were from North America. Sixty-one items were generated of which 4(6.6%) items were rated 'to keep'. These were face symmetry (I-CVI:0.89), salivary control (I-CVI:0.95), alertness (I-CVI:0.89) and choking (I-CVI:0.84). Of all respondents, 31(54.4%) endorsed swallowing trials, of which 25(80.6%) endorsed thin liquid by teaspoon (n = 17, 68%) or open cup (n = 20, 80%). We identified candidate items for bedside dysphagia screening with excellent content validity for acute pediatric stroke patients. Next steps include assessment of the psychometric value of each item in identifying dysphagia in children in the acute stage of recovery from stroke.

Longitudinal dysphagia assessment in adult patients with nephropathic cystinosis using the Modified Barium Swallow Impairment Profile.

Nephropathic cystinosis is a lysosomal storage disorder with known myopathic features, including dysphagia. Evaluation of oropharyngeal swallowing physiology can be standardized using the Modified Barium Swallow Impairment Profile (MBSImP), a validated assessment tool used to analyze and rate swallowing across 17 distinct physiologic domains. Our objective was to better characterize swallowing impairments in nephropathic cystinosis using MBSImP analysis. We retrospectively evaluated 40 video fluoroscopic swallowing studies performed at two time points over 1y in patients with nephropathic cystinosis with various levels of oral and pharyngeal stage dysphagia. Patients completed two self-administered dysphagia outcome measures (the M. D. Anderson Dysphagia Inventory [MDADI] and the 10-item Eating Assessment Tool [EAT-10]). We demonstrated oral stage and pharyngeal stage dysphagia across domains that impacted bolus control, transit, and clearance through both the oral cavity and pharyngeal lumen. Also captured were deficits related to onset and completeness of laryngeal closure that impact airway protection during swallow. There were significant correlations between pharyngeal total score and EAT-10 (r= 0.5, p< 0.001) and between oral total score and EAT-10 (r= 0.7, p< 0.001), MDADI-e (r= -0.6, p< 0.001), MDADI-p (r= -0.5, p< 0.001) and MDADI-c (r= -0.6, p< 0.001). There were no differences in oral or pharyngeal total scores across the 1-y time span. This study identifies oral and pharyngeal stage dysphagia as crucial to patients with nephropathic cystinosis and paves the path for future studies of treatment targets.

Dysphagia assessment and treatment: a guide for nurses

How to identify eating, drinking and swallowing difficulties, often associated with stroke, head and neck cancers and neurological conditions – and provide support

Intensive care professionals’ perspectives on dysphagia management: A focus group study

BackgroundIntensive care unit (ICU)–acquired dysphagia has severe consequences for patients including increased morbidity and mortality. Standard operating procedures, however, including systematic evaluation of swallowing function and access to specialised assessment and training may be limited. Dysphagia management relies on multiprofessional collaboration, but practice is variable and nonstandardised. ObjectiveThe objective of this study was to explore and compare nurses', physicians’, and occupational therapists' perceptions of dysphagia management in the ICU. Materials and methodsSix focus group interviews with 33 participants (23 nurses, four physicians, and six occupational therapists) were conducted and analysed using the framework method with a matrix developed from the first interview. Content from the interviews was plotted into the matrix, condensed, and refined. FindingsClinical dysphagia management depended on recognising signs of dysphagia in patients at risk. Assessment, therapeutic methods, and care differed among professional groups according to knowledge and roles. Interprofessional collaboration and responsibility for dysphagia management across the care continuum was determined by availability of resources, practical skills, knowledge, and formal decision-making competence and judged effective when based on mutual respect and recognition of healthcare professionals' different perspectives. ConclusionSystematic interprofessional collaboration in ICU dysphagia management requires working towards a common goal of preventing aspiration and rehabilitating the patients' ability to swallow safely. This is based on dysphagia assessment, using appropriate therapeutic interventions, sharing knowledge, and improving skills among professional groups.

Evaluación holística semipresencial de la disfagia orofaríngea en el marco de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: optimizar la valoración para mejorar el tratamiento rehabilitador

IntroductionOropharyngeal dysphagia can lead to medical complications and decreased quality of life. Although there is a wide diversity of instrumental and clinical procedures to assess it, consensus for its holistic evaluation is scarce and poorly defined. The objective of this article is to present the design of a model for the holistic examination of oropharyngeal dysphagia that takes into account the components of the International Classification of Functioning, Disability and Health (ICF) and that can be carried out both face to face and semi-presentially using Information and Communication Technology (ICT) tools. Material and methodsA non-systematic review of the literature is carried out in order to select validated oropharyngeal dysphagia assessment tools with the highest degree of recommendation. These tools are analyzed by a group of experts in oropharyngeal dysphagia from the Hospital de la Santa Creu i Sant Pau in Barcelona to design a holistic exploration model. ResultsThis evaluation model includes an assessment at the beginning and at the end of the treatment, as well as continuous monitoring during the rehabilitation process. It is implemented in a semi-presential and multidisciplinary way, and its purpose is to understand oropharyngeal dysphagia holistically to design and monitor an individualized therapeutic plan. ConclusionsThe evaluation of oropharyngeal dysphagia should be within the biopsychosocial framework proposed by the ICF. The application of ICT in blended interventions facilitates this.

Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia assessment methods. Methods: Five major databases were systematically searched through January 2022. A random-effects model for meta-analysis was conducted to obtain the pooled prevalence. Results: Prevalence of dysphagia in the community-dwelling elderly screened by water swallow test was 12.14% (95% CI: 6.48% to 19.25%, I2 = 0%), which was significantly lower than the combined prevalence of 30.52% (95% CI: 21.75% to 40.07%, I2 = 68%) assessed by Standardized Swallowing Assessment (SSA) and volume-viscosity swallow test (V−VST). The dysphagia prevalence among elderly nursing home residents evaluated by SSA was 58.69% (95% CI: 47.71% to 69.25%, I2 = 0%) and by the Gugging Swallowing Screen test (GUSS) test was 53.60% (95% CI: 41.20% to 65.79%, I2 = 0%). The prevalence of dysphagia in hospitalized older adults screened by the 10-item Eating Assessment Tool was 24.10% (95% CI: 16.64% to 32.44%, I2 = 0%), which was significantly lower than those assessed by V-VST or GUSS tests of 47.18% (95% CI: 38.30% to 56.14%, I2 = 0%). Conclusions: Dysphagia is prevalent in the elderly, affecting approximately one in three community-dwelling elderly, almost half of the geriatric patients, and even more than half of elderly nursing home residents. The use of non-validated screening tools to report dysphagia underestimates its actual prevalence.

Resident-Driven Dysphagia Screening Protocol for Expedited Antithrombotic Delivery in Acute Ischemic Stroke.

We implemented a multi-disciplinary process improvement intervention at our Comprehensive Stroke Center with speech/language pathologists to expedite oral medication delivery in stroke patients. Following a failed nursing dysphagia screen, trained neurology physicians screened dysphagia further to approve use of oral medications. We analyzed the safety and efficacy of this intervention. We analyzed retrospectively collected data for hospital course, timing of first screen, first oral medication use, and complications (e.g., aspiration pneumonia) in consecutive ischemic stroke patients (9/2019-07/2021). Patients were included if they passed a dysphagia assessment by physicians (Ph), nurses (RN), or speech/language pathologists (SLP). Arrival-to-dysphagia screen and arrival-to-antithrombotic were assessed using restricted mean survival time (RMST). Of the 789 included patients, 673 were passed by RN, 104 by SLP, and 12 by Ph. Compared to patients passed by SLP, those passed by Ph were younger and had less severe deficits (P < .01 for both). Patients were screened more quickly by Ph than RN or SLP (median 38 vs 182 vs 1330-min post-arrival, P = .0001; 299-min RMST difference vs RN [95%CI 22-575, P = .03]; 470-min RMST difference vs SLP [95%CI 175-765, P = .002]). This translated to faster oral antithrombotic use for Ph-passed patients (138-min RMST difference vs RN [95%CI 59-216]; 332-min RMST difference vs SLP [95%CI 253-411]). No patients passed by Ph experienced aspiration pneumonia (0%). We safely conducted a physician-driven dysphagia screening paradigm which led to faster oral antithrombotic delivery without signal of patient harm. Physician availability to complete dysphagia screens in acute stroke patients was a limitation.

Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis.

Background: Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older adults with symptoms of dysphagia might have a higher prevalence of frailty or prefrailty than those without dysphagia. Methods: We systematically searched the PubMed, Embase, and Cochrane Library databases for relevant studies published through 20 April 2022. Cross-sectional and longitudinal studies that examined the associations between dysphagia and the existence of frailty or prefrailty in community-dwelling, facility-dwelling, or hospitalized adults aged 50 years or older were synthesized. The Newcastle–Ottawa Scale was used to evaluate study quality. Results: The meta-analysis comprised 12 cohorts, including 5,503,543 non-frailty participants and 735,303 cases of frailty or prefrailty. Random-effect meta-analysis demonstrated a significant association between dysphagia and the risk of frailty and prefrailty (OR, 3.24; 95% CI, 2.51–4.20). In addition, we observed consistent results across the subgroups and heterogeneity assessments. Conclusions: We propose including dysphagia assessment as a critical factor in the cumulative deficit model for identifying frailty in older adults. Understanding dysphagia and the potential role of nutritional supplements in older adults may lead to improved strategies for preventing, delaying, or mitigating frailty.

Impedance Planimetry and the Changing Paradigm of Esophageal Dysphagia.

Patients presenting with dysphagia can encounter a pathway to therapy and relief that is expensive and frustrating. High resolution impedance planimetry (HRIP) is a new mechanism for enhancing and possibly hastening that process. A balloon with integrated pressure sensors is utilized to measure luminal geometry and pressure by volume-controlled distention. Esophagogastric junction (EGJ) distensibility and body contractility are assessed at the time of other endoscopic procedures. Here we describe a single-center experience utilizing HRIP in the endoscopic evaluation of patients presenting with dysphagia. A prospectively maintained registry of patients undergoing impedance planimetry assessments at an academic medical center was queried for demographics, procedural details, and patient-reported outcomes. Data was reviewed for 122 procedures performed by two providers. HRIP was performed in 63 (52%) patients for initial dysphagia assessment, 36 (30%) for follow-up assessment, and 20 (16%) as a procedural adjunct at the time of other planned procedures. HRIP contractile response was characterized as normal in 36%, absent in 32%, and diminished/disorganized in 14%. These results motivated clinical planning for surgical referral in 7 (5%) patients, 31 (26%) additional testing, and 82 (68%) continued medical management and follow-up. HRIP is an emerging endoscopic modality which can streamline diagnostic work-up and therapeutic planning for patients with symptomatic dysphagia. Using functional esophageal assessment at the time of other diagnostic and therapeutic procedures, HRIP may expedite care and lead to improved patient satisfaction and clinical outcomes.

Reliability and validity of the Slovenian Translation of the Functional Oral Intake Scale (FOIS-SI)

Background: It is crucial that each and every stroke patient gets a systematic assessment of swallowing disorders, performed by a dysphagia specialist. Therefore, there is a need to use a standardized scale among professionals. The aim of this study was to translate, adapt, and obtain the statistical characteristics of the Functional Oral Intake Scale (FOIS), which is an observer-rated dysphagia severity scale primarily developed for stroke patients, into the Slovenian language.&#x0D; Methods: We performed a 5-step translation and adaptation process. Six speech and language pathologists had evaluated 30 clinical records of patients with an acute ischemic stroke in the carotid artery territory with the Slovenian translation of the Functional Oral Intake Scale (FOIS-SI). Every clinical record included a speech and language clinical bedside assessment of dysphagia, the sex, age, National Institutes of Health Stroke Scale (NIHSS), comorbidities of patients and lesion location. We examined interrater and intrarater reliability and additionally convergent validity of FOIS-SI with the theoretically related IDDSI-Functional Diet Scale (IDDSI-FDS).&#x0D; Results: The average measure Intraclass Correlation Coefficient (ICC) for the interrater reliability (ICC=0.959) and the intrarater reliability (ICC=0.979 and ICC=0.991) for both raters was excellent. The FOIS-SI scores correlated very high with the IDDSI-FDS (rs=0.927).&#x0D; Conclusion: The results of this study show that the Slovenian translation of the FOIS has an excellent interrater and intrarater reliability and very high validity, which implies the FOIS-SI can be used as a tool to quantitatively assess the severity of dysphagia in clinical practice and research in patients with stroke in carotid artery territory across the country in all medical and care settings.

The Role of Dysphagia Assessment in the Identification of Upper Airway Obstruction in Infants.

The Role of Dysphagia Assessment in the Identification of Upper Airway Obstruction in Infants.

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic.

This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies. A retrospective review of electronic patient records was performed between 2016 and 2020. Twenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy. This study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.

Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey

Purpose Patients admitted to critical care (CC) are at risk of impaired swallowing and communication function. Speech-language pathologists (SLPs) play an important role in this context. In Ireland and internationally speech-language pathology CC guidelines are lacking, with possible variations in practice. To compare clinical practices in dysphagia, communication and tracheostomy management among SLPs working in adult CC units in Ireland and internationally, and explore their perspectives on training, skills and resources. Method Participants were SLPs working in CC. An international online survey sought information on (i) SLP workforce demographics and staffing levels, (ii) current dysphagia and communication assessment and management practices, (iii) practices and perspectives on training, skills and resources. Result 366 responses were received across 29 countries. 18.03% (66/366) of these respondents worked in Ireland. Findings showed similarities and differences in practices. Total CC SLP whole-time equivalent (WTE) at each staff grade was lower (mean difference: −0.21 to −0.65 WTE p <.001) than desired for optimal service delivery. Negative effects of under-staffing were reported. Recommendations that all tracheostomised patients receive SLP input was unmet in 66% (220/334) of services. Conclusion SLP input in CC is limited in terms of dedicated posts, multidisciplinary team (MDT) involvement, consistent management approaches and training opportunities internationally. Implications of findings are discussed.

Treatment Strategies in Adult Dysphagia

Background. Swallowing disorders are becoming more common in an aging society, so it is important to understand and know the phases of swallowing, including the voluntary and involuntary aspects of the swallowing process, in order to be able to apply strategies to overcome swallowing disorders.&#x0D; Aim. To reveal the strategies in adult dysphagia treatment.&#x0D; Methods. Theoretical scientific research. This method enables to reveal and analyse the concept of swallowing disorders in the context of Lithuania and foreign countries, analyzes the variety of rehabilitation strategies applied to overcome swallowing disorders, and emphasizes the importance of complex dysphagia assessment and treatment. Adult dysphagia treatment strategies are compared and summarized.&#x0D; Results. The analysis of Lithuanian and foreign science research showed that complex strategies are most often applied for adult dysphagia treatment. Rehabilitative dysphagia treatment strategies are used to accelerate the recovery of swallowing function, and compensatory strategies are applied to ensure patient safety during eating.&#x0D; Conclusion. In each case, speech therapy differs depending on individual personal and external factors that affect swallowing disorder. Adult dysphagia treatment is usually complex in Lithuania: both rehabilitative and compensatory models are applied in dysphagia treatment.&#x0D; Keywords: swallowing disorders, dysphagia treatment strategies, rehabilitative dysphagia treatment strategies, compensatory dysphagia treatment strategies.

Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10.

The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69years) participated. The test-retest reliability (time interval = 7days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.

Abstract WMP32: EMR Alert Improves Compliance With Dysphagia Assessment In Stroke Patients

Introduction: Dysphagia in patients after a stroke is very common. There is a risk factor for aspiration pneumonia and is associated with worse patient outcomes. The American Heart Association guidelines recommend that a swallow screening be performed on all stroke patients prior to any oral intake. Stroke can present with a variety of symptoms and may not be identified at the time of the patient’s presentation. In analyzing patient data in which the dysphagia screening was not completed, it was identified to occur at the first oral intake of a medication. Our hypothesis is that if the nurse was alerted at the time of medication administration that a dysphagia screening needs to be completed, we could improve our compliance with this quality measure. Method: A new Electronic Medical Record (EMR) process was developed, that based on certain criteria, triggered an alert for the nurse when the first oral medication barcode was scanned. Within the alert there is a link to document the dysphagia screening. After documentation of the screening, the nurse is returned to the medication administration record to continue her administration. The criteria for triggering the alert is twofold. The first trigger is based on the presenting chief complaint on arrival to the emergency department. These would include chief complaints such as stroke symptoms, dizziness, weakness, etc. The second trigger occurs when the physician enters an order for dysphagia screening to be completed by nursing. With each of these triggers, the EMR logic looks to see if a dysphagia screen has already been documented and the alert only is generated if it has not. This process was initiated in the EMR in February 2021 for all 12 hospitals in the University Hospitals health system. Results: At University Hospitals Parma Medical Center dysphagia screening compliance improved from 82% in QTR 3 2020 to 90% in QTR 2 2021. Overall, in the University Hospital health system compliance improved from 85% in QTR 3 2020 to 89% in QTR 2 2021. Conclusion: An EMR alert has assisted the nurse to remember to complete this important dysphagia screening and improved compliance with this quality measure. In addition, nurses have reported an increase in satisfaction with the new workflow.