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Nursing Research and Practice
Volume 2013 (2013), Article ID 304190, 7 pages
http://dx.doi.org/10.1155/2013/304190
Research Article

Implementation of Stroke Dysphagia Screening in the Emergency Department

1Research Service Line, Department of Communication Sciences and Disorders, Michael E. DeBakey VA Medical Center and University of Houston, 2002 Holcombe Boulevard, Houston, TX 77030, USA
2Health Services Research and Development Center of Excellence, Department of Neurology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
3Health Services Research and Development Center of Excellence, Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA

Received 11 October 2012; Accepted 14 January 2013

Academic Editor: Deborah Vincent

Copyright © 2013 Stephanie K. Daniels et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy-eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran-Armitage test ). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening.