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Swallow management in patients on an acute stroke pathway: quality is cost effective.

OBJECTIVE: To assess the effects of swallowing management in patients with acute nonhemorrhagic stroke placed on a clinical pathway, and to evaluate whether swallow function on admission can be used as a predictor of length of stay (LOS) and outcome disposition.

DESIGN: Intervention study to reduce complications of dysphagia in patients with acute stroke.

SETTING: Urban community hospital.

PATIENTS: Data were collected on 124 patients with acute nonhemorrhagic stroke admitted from January to December 1993.

INTERVENTIONS: A swallow screen was completed within one day of admission and before any oral intake.

MAIN OUTCOME MEASURES: Dysphagia and functional independence measure (FIM) scores on admission, occurrence of aspiration pneumonia, LOS, outcome disposition and cost effectiveness analysis.

RESULTS: Thirty-nine percent of all patients (p < .05) failed the initial swallow screen and required altered dietary texture and intervention. No patients developed aspiration pneumonia. Of those with dysphagia, 21% recovered intact swallowing by discharge; 19% required gastrostomy tube placement. Patients with dysphagia had lower admission FIM scores than nondysphagia patients. The LOS was longer for the dysphagia group (8.4 +/- 0.9 days) compared with patients without dysphagia (6.4 +/- 0.6 days, p < .05). Patients with dysphagia were less likely to be discharged to home (27%) than were nondysphagia patients (55%), and twice as likely to be discharged to a nursing home (p < .05).

CONCLUSIONS: This study demonstrates that early swallow screening and dysphagia management in patients with acute stroke reduces the risk of aspiration pneumonia, is cost effective, and assures quality care with optimal outcome.

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