Quality Improvement Initiative Using Predictive Swallowing Score to Guide Nutritional Support for Patients With...

Decisions on enteral nutrition for patients with dysphagia after acute ischemic stroke (AIS) are often not evidence based. We sought to determine whether development of a nutritional support algorithm leveraging the Predictive Swallowing Score (PRESS) could improve process times without placement of unnecessary gastrostomies.

This is a quality improvement study conducted at an academic medical center comparing a 6-month cohort of adults with AIS and dysphagia prepathway (PRE, July 1, 2019-December 31, 2019) and a 6-month cohort postpathway (POST, January 1, 2020-June 30, 2020). Gastrostomy recommendation, time to gastrostomy decision (TTD), discharge with gastrostomy, discharge with a nasogastric tube (NGT), and length of stay (LOS) were compared between groups.

Among 121 patients with AIS and dysphagia, 58 (48%) were hospitalized prealgorithm and 63 (52%) postalgorithm. PRE TTD was longer than POST TTD (4.5 vs 1.5 days, p = 0.004). Frequency of gastrostomy was similar between PRE and POST (12% vs 8%, p = 0.58). LOS for patients recommended gastrostomy was longer in PRE (14.5 vs 6.5 days, p = 0.03). Frequency of discharge with NGT was numerically higher in POST but not significantly different (0.7% vs 6%, p = 0.4). Overall, LOS was the same in both groups (5 days).

Development of a structured nutritional support algorithm incorporating PRESS may help facilitate sooner gastrostomy placement without increasing gastrostomy placement frequency and encourage more discharges to inpatient rehabilitation facilities with NGTs.