Implementing a systematic care pathway for management of dysphagia after cardiothoracic surgery |
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| Institution: | 1. Speech Science, The University of Auckland, Grafton Campus, The University of Auckland, Private Bag 92019, Auckland, New Zealand;2. Auckland District Health Board, Auckland Hospital, Grafton Road, Auckland, New Zealand;1. Intensive Care Department, Centre Hospitalier Universitaire Brugmann, ULB University, Brussels, Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium;2. HOGENT University of Applied Sciences and Arts, School of Healthcare, Keramiekstraat 80, 9000 Ghent, Belgium;1. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand;2. Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand;1. Department of Emergency, The First Medical Center of PLA General Hospital, Beijing 100000, China;2. Endoscopy Center, Hainan Hospital of PLA General Hospital, Sanya 572013, China;1. Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy;2. Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy;1. Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria;2. Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria;3. Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23 Bauteil 86 2. Stock, 1090 Vienna, Austria;4. Department Department of Internal Medicine, Cardinal Schwarzenberg Hospital, Schwarzach i. Pongau, Austria;1. Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway;2. Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål sykehus, Postboks 4956 Nydalen, 0424 Oslo, Norway;3. Faculty of Health Science, OsloMet – Oslo Metropolitan University, Oslo, Norway;4. Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway;5. Faculty of Health Studies, VID Specialized University, Oslo, Norway |
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| Abstract: | ObjectivesThis longitudinal quality improvement study explored the impact of a new multidisciplinary dysphagia care pathway on swallow screening referrals, patient journeys and swallow outcomes in patients after cardiac surgery.Research methodologyThe new dysphagia care pathway consisted of i) nurse chart review triaging using established risk factors, ii) nurse swallow screening (including a cough reflex test and water swallow test) and iii) rapid referral routes to speech pathology. All patients referred for swallow screening in 2020 after the commencement of the new dysphagia care pathway were included (n = 114). Data was compared to two historical, published data sets at the research site (n-41 in 2012–2013 and n = 121 in 2013–2016).SettingCardiovascular intensive care unit.Results52% failed chart review and 29% failed cough reflex test. All patients who passed chart review and cough reflex test returned to a normal diet without need for speech pathology referral. Silent aspiration rates were high in those who failed chart review and the cough reflex test (42%, 43% respectively). For those who received a swallow screen, enteral feeding rates were 70% on first assessment and 27% by discharge from the unit in historical data (2013–2016). In comparison, in 2020, enteral feeding rates were 44% and 8% respectively.ConclusionsReferrals for nurse swallow screening and speech pathology increased following the introduction of the care pathway. There has been a reduction in enteral feeding rates and length of enteral feeding at discharge. High rates of silent aspiration in those who fail screening suggests stepwise nurse dysphagia screening successfully picks up at-risk patients. |
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| Keywords: | Cardiac surgery Dysphagia Speech-language pathology Silent aspiration |
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