Short ‘n Sweet – Hospital Discharge Dysphagia Omissions

We come. We evaluate. We treat. We recommend. We leave.

That seems to be the simplistic sequence, right? Ever wonder what happens to those recommendations we all so fervently include though? Well, that’s just what these authors wanted to find out! There’ll be a ton of lessons to learn, and this seems to be just the start.🤯

---

Title: Omission of Dysphagia Therapies in Hospital Discharge Communications
Authors: Kind, Anderson, Hind, Robbins, & Smith
Journal: Dysphagia
Year of Publication: 2011
Design Type: Retropective Cohort Study
Purpose: “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.“
Population: 40 healthy female participants
Inclusion criteria: >18⁺ yrs at a single large academic medical center; stroke/hip fracture ICD-9 diagnosis codes with Speech Therapy CPT-related dysphagia codes required
Exclusion criteria: Patients were excluded if they did not have a discharge summary (N = 2), did not have dysphagia recommendations listed in their SLP hospital chart notes, were discharged to hospice or comfort care, if it was clear from their discharge summary that they did not have a diagnosis of stroke or, or were not discharged to a subacute care facility, for a final sample size of 187

---

Dysphagia Recommendation Categories:

• 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)
• Provider/ supervision (e.g., 1-to-1 assist)
  • _{(Subcategories provided in their Table 1)}

Based on the final SLP hospital notes and hospital physician discharge summaries….

“Overall, 45% of patient discharge summaries omitted all of the dysphagia recommendations made within the final SLP hospital note, while 42% of discharge summaries omitted at least one (but not all) of the SLP recommendations (i.e., omitted some recommendations).”

Specific omitted recommendations:

• 47% Dietary (food and liquid)
• 82% Postural/compensatory techniques
• 100% Rehabilitation
• 90% Meal pacing
• 95% Medication delivery
• 79% Provider/ supervision

---

Takeaway:

While obviously 1 single large facility doesn’t speak for all others in the country and the focus was on only 2 diagnoses…

We need better comprehensive discharge summaries!!

Possible future suggestions/solutions:

• Join/Start a discharge committee focusing on rehabilitation therapies
• Work closely with case managers and physicians on discharge recommendations
• Learn more about the discharge process at your facility
• Connect with other SLPs at subacute/long-term facilities to improve closed-loop communication

What are some other solutions that you, your department, or your facility have found to be helpful to improve this issue?!??

---

---

Article Referenced: [FREE ACCESS]

Kind, A., Anderson, P., Hind, J., Robbins, J., & Smith, M. (2010). Omission of Dysphagia Therapies in Hospital Discharge Communications. Dysphagia, 26(1), 49-61. doi: 10.1007/s00455-009-9266-4