An inter-disciplinary approach to swallowing problems in acute stroke

Many speech and language therapy (SLT) departments are in danger of being s wamped with dysphagia referrals, often to the detriment of other work. At t he same time surveys have shown that large numbers of patients with acute s troke have swallowing problems which are poorly managed during die critical early phase, not referred or missed altogether. The Collaborative Dysphagi a Audit (CODA) study, carried out in sis British hospitals, showed that nur ses could quickly be trained to carry out basic screening assessments for d ysphagia and that implementation of a co-ordinated inter-disciplinary dysph agia management policy (DMP) could substantially improve the proportion of dysphagic patients in whom appropriate feeding precautions were taken. Thes e early DMPs were: limited by the need for ward staff to keep all patients with suspected swallowing impairment nil by mouth until assessed by SLT, so in some acute stroke units nurses have: been trained to a higher level whi ch allows them to manage most routine transient swallowing problems, leavin g only complex or persistent cases for referral to SLT. This approach has b een used successfully in our unit in Gateshead, where a dysphagia nurse spe cialist post has been set up to act as a link between ward staff and SLTs, to ensure that the necessary training levels are maintained and to co-ordin ate the DMP.