[Improving the Nasogastric Tube Removal Rate in Stroke Patients Using a Quality Control Circle Method]

Post-stroke dysphagia, which affects 40% to 70% of stroke survivors, frequently leads to aspiration pneumonia and diminished quality of life. Despite achieving a 98.8% initial swallowing screening rate, the nasogastric tube removal rate in our unit of 52.7% was below the national benchmark of 57.4%. A quality control circle root cause analysis was conducted, with five critical issues identified. These included a lack of routine in-service education, insufficient interdisciplinary collaboration, inconsistent screening tool versions being used, a deficit in integrated educational resources, and ambiguous re-screening protocols during patient transfers that resulted in a low re-screening rate (60.3%).

This project was implemented to increase the nasogastric tube removal rate in stroke patients from the baseline of 52.7% to a minimum target of 67.8%.

Four key interventions were implemented using quality control circle methodologies. These included: (1) Organizing interdisciplinary workshops to clarify intervention timing and professional roles across disciplines; (2) Integrating a "Three-Stage Swallowing Screening Tool" incorporating pre-procedural oral hygiene protocols and clinical decision-making algorithms; (3) Developing interdisciplinary patient education materials encompassing nursing, traditional Chinese medicine, and speech-language pathology; and (4) Revising standard operating procedures to mandate re-screening during all inter-unit transfers.

Post-intervention, the nasogastric tube removal rate increased from 52.7% to 69.9%, which exceeded the targeted goal. Notably, no re-intubations occurred within the six-month post-discharge follow-up period. In addition, the re-screening rate during inter-unit transfers improved markedly from 60.3% to 97.4%. Ancillary benefits included redirecting approximately 15 minutes of tube maintenance time per nurse daily into high-value individualized patient care,and an estimated savings in annual healthcare costs of NT$24,708 per family.

The process standardization and enhanced interdisciplinary synergy achieved under this project effectively eliminated gaps in care, resulting in substantially improved patient safety and care quality.