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

Purpose: There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012.Method: Chart auditing was completed for 83 participants in three groups: pre-protocol (n=12) (2011), post-protocol (n=28) (2012-2014), and non-thrombolysed stroke patients (n=43).Result: Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by $1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups.Conclusion: 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.