Abstract TMP95: A Prospective Quality Initiative to Maximize Dysphagia Screening Prevents Stroke Associated Pneumonia

BACKGROUND AND PURPOSE: Dysphagia can lead to pneumonia and subsequent death following acute stroke. However, no prospective study has demonstrated reduces pneumonia rates after implementation of a dysphagia screen. METHODS: This was a single-center prospective interrupted time series trial of a dysphagia screening quality initiative. Subjects included all ischemic or hemorrhagic strokes over a 42-month period with a 31-month (n=1686) pre-intervention period and an 11-month (n=648) post intervention period. The multifaceted interdepartmental quality improvement initiative centered on a nurse-administered dysphagia screen with rapid speech pathology evaluation. RESULTS: The dysphagia screening initiative increased the percentage of stroke patients screened from 39.3% to 74.2% (p<0.001). Increased screening correlated with a drop in stroke-associated pneumonia from 6.5% to 2.8% (p<0.001). Patients admitted post-initiative had 53% lower odds of pneumonia, after controlling for multiple confounds (OR=0.43, CI=[0.255, 0.711], p=.0011). The best predictors of pneumonia were stroke type (p<.0001), NPO status (p<0.0001), dysphagia screening status (p=.0037), and hospitalization prior to the initiative (p=.0449). By using a nurse-administered bedside screen and streamlining of protocols 11.5% of speech pathology referrals came directly from nurses without a physician order. CONCLUSION: A quality improvement initiative utilizing a nurse-administered bedside screen improves screening rates and is associated with decrease pneumonia among stroke patients.