Meal observations, guideline compliance, and patient outcomes in patients with stroke before and after guideline implementation
| Outcomes | Before n (%) | Aftern (%) | Significance* |
|---|---|---|---|
| *Calculated using chi square test unless otherwise indicated; NS = not significant | |||
| † Mann-Whitney U-test | |||
| ‡Calculated from numbers of patients with specific impairments that affect eating and treated with occupational therapy and physical therapy. | |||
| Meal observations (n=120, 42 stroke patients) | |||
| Eat independently | 39 (32) | 13 (31) | |
| Need assistance to eat | 48 (40) | 17 (40) | |
| Need feeding | 18 (15) | 9 (21) | |
| Tube fed | 8 (7) | 3 (7) | NS† |
| Assisted to eat by relatives | 5 (4)* | 2 (5)* | |
| Fed by relatives | 8 (7)* | 1 (2)* | NS† |
| Guideline compliance(n=200 before, n=200 after, all stroke patients) | |||
| Swallowing function screened within 24 hours | 106 (53) | 123 (62) | <0.001 |
| Screened for dysphagia using validated tool | 0 | 64 (32) | <0.001 |
| Screened for nutritional risk within 24 hours | 3 (1) | 36 (18) | <0.001 |
| Use of validated nutrition risk tool for screening | 6 (3) | 53 (26) | <0.001 |
| Use of validated nutrition risk tool for monitoring | 35 (17) | 74 (37) | <0.001 |
| Referrals to physiotherapy‡ | 61–63% | 91–92% | p<0.001 |
| Referrals to occupational therapy‡ | 58–70% | 82–84% | p<0.001 |
| Nutritional support decision making deferred beyond day 5 | 35 (17) | 12 (6) | <0.001 |
| Tube fed | 33 (16) | 27 (13) | NS |
| Tube feeding implemented and established (>50% prescription delivered) | 17/33 (51) | 22/27 (81) | <0.016 |
| Referral to SLT | 74 (37) | 80 (40) | NS |
| Weighed within first 5 days | 58 (29) | 66 (33) | NS |
| Patient outcomes | |||
| Chest infection, aspiration pneumonia, or sepsis | 33 (16) | 13 (6) | <0.003 |