Safe initiation of oral diets in hospitalized patients based on passing a 3-ounce (90cc) water swallow challenge protocol
Source: QJM: An International Journal of Medicine, Volume 105, Number 3, 14 March 2012 , pp. 257-263(7)
Publisher: Oxford University Press
Abstract:Background: Safe and timely oral alimentation is crucial for optimum patient care.
Objective: To determine the short-term success of recommending specific oral diets, including drinking thin liquids, to acute care hospitalized patients at risk for dysphagia based on passing a 3-ounce water swallow challenge protocol.
Design: Prospective single group consecutively referred case series.
Setting: Large, urban, tertiary care, teaching hospital.
Participants: 1000 hospitalized patients.
Intervention: 3-ounce (90cc) water swallow challenge protocol.
Measurements: Specific diet recommendations and volume (in cc) of liquid ingested at the next day's meal 1224h after passing a 3-ounce challenge protocol were accessed electronically from oral intake information entered on each participant's daily care logs. Eating and drinking success, clinically evident aspiration events and compliance with ordering the recommended diet were recorded. Care providers were blinded to the study's purpose.
Results: Of 1000 patients, 907 met the inclusion criteria of stable medical, surgical or neurological conditions 1224h after passing a 3-ounce water swallow challenge protocol. All 907 were both eating and drinking thin liquids successfully and without overt signs of dysphagia. Median volume of liquid ingested was 340cc [interquartile range (IQR), 240460]. Specific diet recommendations were followed with 100 accuracy.
Conclusions: A 3-ounce water swallow challenge protocol successfully identified patients who can be safely advanced to an oral diet without subsequent identification of overt signs of aspiration within 1224h of testing. Importantly, when a clinical 3-ounce challenge protocol administered by a trained provider is passed, specific diet recommendations, including drinking thin liquids, can be made safely and without the need for additional instrumental dysphagia testing.
Document Type: Research Article
Affiliations: 1: From the Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, , 2: Audiology & Speech-Language Pathology, Veterans Affairs Medical Center, Memphis, TN, , 3: Speech and Swallow Center, Yale-New Haven Hospital, New Haven, CT and , 4: Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT,
Publication date: 2012-03-14
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