Dysphagia Grand Rounds 7

Despite the wide implementation of dysphagia therapies, it is unclear whether dysphagia-related SLP recommendations are being successfully communicated beyond the inpatient hospital setting. Poor discharge communication could lead to inappropriate post-hospital dysphagia care, with resultant aspiration pneumonia and need for costly rehospitalizations.

Dysphagia Grand Rounds 7 reviews a retrospective cohort study, investigating the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk subacute care patients. Read the paper below to see what the authors found and then watch the DGR  webinar to learn about the clinical implications of these findings. 

Article: Omission of Dysphagia Therapies in Hospital Discharge Communications
Authors: Amy Kind, Paul Anderson, Jacqueline Hind, Joanne Robbins, and Maureen Smith Journal: Dysphagia. 2011;26(1):49-61. 

Read DGR 7 article here:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888892/ 

Watch DGR 7 webinar here: http://dysphagiagrandrounds.yondo.com/playlist/dgr-7-july-2017/382

Abstract: 
Background
Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting.

Objective
To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations.

Design
Retrospective cohort study

Subjects
All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187).

Measurements
Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist).

Results
45% of discharge summaries omitted all SLP dysphagia recommendations. 47% (88/186) of patients with SLP dietary recommendations, 82% (93/114) with postural, 100% (16/16) with rehabilitation, 90% (69/77) with meal pacing, 95% (21/22) with medication, and 79% (96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries.

Conclusions
Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care.