Original Article

Dysphagia

, Volume 26, Issue 1, pp 49-61

Omission of Dysphagia Therapies in Hospital Discharge Communications

  • Amy KindAffiliated withGeriatrics Section, Department of Medicine, University of Wisconsin School of Medicine and Public HealthGeriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, United States Department of Veterans AffairsDepartment of Population Health Sciences, University of Wisconsin School of Medicine and Public Health Email author 
  • , Paul AndersonAffiliated withGeriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, United States Department of Veterans AffairsUniversity of Wisconsin School of Medicine and Public Health
  • , Jacqueline HindAffiliated withGeriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, United States Department of Veterans AffairsGastroenterology and Hepatology Section, Department of Medicine, University of Wisconsin School of Medicine and Public Health
  • , JoAnne RobbinsAffiliated withGeriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, United States Department of Veterans AffairsGastroenterology and Hepatology Section, Department of Medicine, University of Wisconsin School of Medicine and Public Health
  • , Maureen SmithAffiliated withDepartment of Population Health Sciences, University of Wisconsin School of Medicine and Public HealthDepartment of Family Medicine, University of Wisconsin School of Medicine and Public Health

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Abstract

Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. The aim of this study was to examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk subacute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. We performed a retrospective cohort study that included all stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to subacute care from 2003 through 2005 from a single large academic medical center (N = 187). Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included dietary (food and liquid), postural/compensatory techniques (e.g., chin tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Forty-five percent of discharge summaries omitted all SLP dysphagia recommendations. Forty-seven percent (88/186) of patients with SLP dietary recommendations, 82% (93/114) with postural, 100% (16/16) with rehabilitation, 90% (69/77) with meal pacing, 95% (21/22) with medication, and 79% (96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to subacute care.

Keywords

Care management Communication Continuity of care Hospital discharge Deglutition Deglutition disorders