Niamh Ní Dhufaigh, Michelle Hayes
Our Lady of Lourdes Hospital, Drogheda, Ireland
Background: Dysphagia is present in approximately two-thirds of patients within the
first three days of onset of stroke. Early detection of dysphagia reduces pulmonary complications,
length of stay and healthcare costs. National Clinical Guidelines recommend
that patients are seen by Speech and Language therapists (SLTs) for initial assessment
within 48 hours of admission. The objective of this audit was to ascertain if stroke
patients admitted to the acute hospital were assessed by SLT within 48 hours of admission,
and whether those patients had improved dysphagia outcomes compared with those
seen after 48 hours, as measured by the Therapy Outcome Measures (TOMs), occurrence
of LRTIs on admission, and rate of readmissions with LRTIs.
Methods: Retrospective database review of all stroke admissions from January to
December 2016. Descriptive analysis carried out with Microsoft Excel and quantitative
analysis carried out using GraphPad Software – Prism 7. TOMs is a 6-point scale for dysphagia
(0 = Severe, 5 = No Dysphagia).
Results: SLT received referrals for 70% (n = 137) of all stroke presentations (N =
195). Of patients referred: 66% referred within 48 hours, with 98% seen by SLT
within 48 hours of receipt of referral. Day of admission impacted average length of
time awaiting referral to SLT, which was significant (p = 0.0015). 64% of patients
were seen within 48 hours of admission (Group A) and 36% were seen after 48 hours
Group A showed greater improvement in TOMs score (x = 1.6) compared to Group
B (x = 0.6), had significantly fewer LRTIs prior to SLT involvement (13%) than group B
(27%; p = 0.0424) and had a lower rate of readmissions with LRTIs (17% versus 21%).
Conclusions: Patients who are seen by SLT within National Guidelines timeframe have
better dysphagia outcomes. This audit highlights the need for early recognition of dysphagia
in the acute stroke setting.