Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol

Abstract

The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.

Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review

“…A second evaluation phase was carried out with full text review of the 77 remaining studies. After this second evaluation phase, 67 articles were excluded because they did not meet the criteria for inclusion (44 were not economic evaluation studies, 10 were partial economic evaluation studies, 6 did not refer to OD, in 1 study OD was not related to stroke, 5 were duplicated articles, and 1 did not fulfil the publication criteria as it was an abstract); finally, 10 articles were included in this systematic review ( Figure 1 ) [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…Three of these studies had a longitudinal design, and one was a model-based study. Study sample size ranged from 83 to 5909 adult (≥18 year) participants [ 36 , 37 , 38 , 39 ]. Each study was performed in a different country: China [ 36 ], Denmark [ 37 ], the United States [ 38 ], and Australia [ 39 ].…”

“…Study sample size ranged from 83 to 5909 adult (≥18 year) participants [ 36 , 37 , 38 , 39 ]. Each study was performed in a different country: China [ 36 ], Denmark [ 37 ], the United States [ 38 ], and Australia [ 39 ]. The Chinese, Australian and Danish studies evaluated cost-savings [ 36 , 37 , 39 ], and the study performed in the United States was a cost-effectiveness study [ 38 ].…”

“…Schwarz, M. et al assessed the impact of an OD screening protocol in which OD was assessed by a speech-language pathologist in thrombolysed ischemic stroke patients on the operational outcomes (hospitalisation cost, length of stay, and sanitary service compliance) from the hospital perspective. This study found a non-significant reduction in hospital costs of 1505 Australian dollars (18,053 vs. 16,548 Australian dollars) when a clinical protocol aimed at managing dysphagia in post-stroke thrombolysed patients was utilized [ 39 ].…”

“…et al did not find significant differences in total hospitalisation costs in China though significant and relevant reductions in pneumonia occurrence and in the rate of nasogastric tube feeding when the V-VST was systematically used [ 36 ]. A non-significant reduction of 1505 Australian dollars in hospital costs during admission was found when assessing the implementation of a protocol aimed to manage OD in post-stroke thrombolysed hospitalised patients [ 39 ]. However, an independent reduction in hospitalisation costs in Denmark was observed in patients in whom swallowing function was assessed early after acute stroke (first 24 h) compared to those in whom it was delayed [ 37 ].…”