Background and Issues: A common symptom of stroke, dysphagia leaves patients vulnerable to aspiration pneumonia and at risk for poor outcomes, mortality, and increased length of stay and healthcare costs. Evidence-based practice indicates early detection of dysphagia is fundamental in decreasing the risk of aspiration, yet often the opportunity is missed in the process of providing emergent care. Stroke patients should be screened for dysphagia and aspiration risk upon ED arrival using a standardized tool before receiving oral intake. Purpose: The goal was to emphasize early dysphagia screening with a standardized screening tool, achieving ≥ 85% compliance in this high-risk population. Methods: Cause-and-effect analysis was used throughout the improvement initiative. Focus was applied to staff recognition of stroke patients as high risk for dysphagia and associated complications. A standardized screening tool was adopted. Missed screening opportunities were identified, revealing frequent association with time-sensitive medication administration of antithrombotics in the ED. A six month pilot was conducted in the ED; an alert was programmed into the medication dispensing station to query the user regarding patient dysphagia risk when specific antithrombotics were dispensed. Control charts were used to measure compliance. Results: Screening compliance significantly improved more than 23% from 1Q2016 to 1Q2019. The standardized screening tool supported inter-rater reliability. The ED pilot improved compliance to 88%, revealing opportunities to improve screening compliance in acute care units. Conclusions: A standardized screening tool and medication alert in the ED improved dysphagia screen compliance, suggesting similar outcomes if implemented on acute care units. Further data will be valuable to hypothesize a negative correlation between sustained dysphagia screening compliance and decreased incidence of healthcare-associated aspiration pneumonia.