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Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

Speech and Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
Division of Cardiovascular Sciences, University of Manchester, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK
School of Population Health and Environmental Sciences, King’s College London, London SE1 1UL, UK
Author to whom correspondence should be addressed.
Geriatrics 2019, 4(4), 60;
Received: 11 September 2019 / Revised: 20 October 2019 / Accepted: 23 October 2019 / Published: 25 October 2019
(This article belongs to the Special Issue The Rehabilitation and Management of Dysphagia)
(1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines. View Full-Text
Keywords: acute stroke; dysphagia; stroke-associated pneumonia acute stroke; dysphagia; stroke-associated pneumonia
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MDPI and ACS Style

Eltringham, S.A.; Smith, C.J.; Pownall, S.; Sage, K.; Bray, B. Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study. Geriatrics 2019, 4, 60.

AMA Style

Eltringham SA, Smith CJ, Pownall S, Sage K, Bray B. Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study. Geriatrics. 2019; 4(4):60.

Chicago/Turabian Style

Eltringham, Sabrina A., Craig J. Smith, Sue Pownall, Karen Sage, and Ben Bray. 2019. "Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study" Geriatrics 4, no. 4: 60.

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