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

Autor:	Zhang L; Cooper Medical School of Rowan University, Camden, NJ, USA.; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA.; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Kamen S; Cooper Medical School of Rowan University, Camden, NJ, USA.; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA.; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Niles J; Cooper Medical School of Rowan University, Camden, NJ, USA., Goss J; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA., Heslin ME; Cooper Medical School of Rowan University, Camden, NJ, USA.; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA.; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Vigilante N; Cooper Medical School of Rowan University, Camden, NJ, USA.; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA.; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Thau L; Cooper Medical School of Rowan University, Camden, NJ, USA.; Department of Speech and Language Pathology, Cooper University Hospital, Camden, NJ, USA.; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Edwards C; Cooper Medical School of Rowan University, Camden, NJ, USA., Marden KR; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Thon JM; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Yeager T; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.
Jazyk:	angličtina
Zdroj:	The Neurohospitalist [Neurohospitalist] 2022 Jul; Vol. 12 (3), pp. 467-475. Date of Electronic Publication: 2022 May 06.
DOI:	10.1177/19418744221098384
Abstrakt:	Background: 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. Methods: 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). Results: 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%). Conclusions: 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. Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s) 2022.)
Databáze:	MEDLINE
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