Barbara Ebersole1,2, Miriam Lango1,3, John Ridge1,3, Elizabeth Handorf4, Jeffrey Farma3, Sarah Clark1,2, Nausheen Jamal5. 1. Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. 2. Department of Speech Pathology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA. 3. Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA. 4. Department of Biostatistics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA. 5. Department of Surgery, University of Texas Rio Grande Valley School of Medicine, University of Texas Health, Edinburg, Texas, USA.
Abstract
OBJECTIVE: Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. METHODS: A prospective single-institution quality improvement dysphagia screening protocol at a comprehensive cancer center. Effect of dysphagia screening implemented in 2016 on hospital-acquired aspiration pneumonia rates coded "aspiration pneumonitis due to food/vomitus" was compared with rates from 2014 to 2015 prior to implementation. Screening compliance, screening outcomes, patient demographics, and medical data were reviewed as part of a post hoc analysis. RESULTS: Of 12,392 admissions in 2014 to 2016, 97 patients developed aspiration pneumonia during their hospitalization. No significant change in aspiration pneumonia rate was seen during the dysphagia screening year when compared to prior years (baseline, 7.36; screening year, 8.78 per 1000 discharges; P = .33). Sixty-eight of the cases (66%) were associated with emesis/gastrointestinal obstruction or perioperative aspiration and only 15 (15%) with oropharyngeal dysphagia. Multivariate analysis found that patients admitted to gastrointestinal surgery had an aspiration risk equivalent to patients admitted to head and neck, thoracic, and pulmonary services (odds ratio, 0.65; P = .2). DISCUSSION: Nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.
OBJECTIVE: Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. METHODS: A prospective single-institution quality improvement dysphagia screening protocol at a comprehensive cancer center. Effect of dysphagia screening implemented in 2016 on hospital-acquired aspiration pneumonia rates coded "aspiration pneumonitis due to food/vomitus" was compared with rates from 2014 to 2015 prior to implementation. Screening compliance, screening outcomes, patient demographics, and medical data were reviewed as part of a post hoc analysis. RESULTS: Of 12,392 admissions in 2014 to 2016, 97 patients developed aspiration pneumonia during their hospitalization. No significant change in aspiration pneumonia rate was seen during the dysphagia screening year when compared to prior years (baseline, 7.36; screening year, 8.78 per 1000 discharges; P = .33). Sixty-eight of the cases (66%) were associated with emesis/gastrointestinal obstruction or perioperative aspiration and only 15 (15%) with oropharyngeal dysphagia. Multivariate analysis found that patients admitted to gastrointestinal surgery had an aspiration risk equivalent to patients admitted to head and neck, thoracic, and pulmonary services (odds ratio, 0.65; P = .2). DISCUSSION: Nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.
Authors: Louise A Burton; Rosemary Price; Karen E Barr; Sean M McAuley; Jennifer B Allen; Aoibhinn M Clinton; Gabby Phillips; Charis A Marwick; Marion E T McMurdo; Miles D Witham Journal: Age Ageing Date: 2015-12-18 Impact factor: 10.668
Authors: Amir Qaseem; Vincenza Snow; Nick Fitterman; E Rodney Hornbake; Valerie A Lawrence; Gerald W Smetana; Kevin Weiss; Douglas K Owens; Mark Aronson; Patricia Barry; Donald E Casey; J Thomas Cross; Nick Fitterman; Katherine D Sherif; Kevin B Weiss Journal: Ann Intern Med Date: 2006-04-18 Impact factor: 25.391