This measure is used to assess the percentage of ischemic stroke patients age 18 years and older initially presenting with acute symptoms of ischemic stroke who are assessed with a swallow screening test before receiving food, fluids or medications by mouth.

The priority aim addressed by this measure is to increase the percentage of stroke patients age 18 years and over who receive appropriate medical management within the initial 24 to 48 hours of diagnosis for prevention of complications such as:

• Dehydration
• Aspiration
• Hypoglycemia and hyperglycemia
• Deep vein thrombosis
• Immobility
• Falling
• Nutritional status decline
• Hyperthermia

Stroke is the fourth leading cause of death, recently dropping from third after decades long efforts to reduce incidence by treatment of risk factors. It remains the leading cause of disability among adults. Costs of hospitalizations, other cares and lost wages are simply enormous.

Pneumonia is a common finding among patients with acute stroke, its incidence ranging from 6% to 32%, and it is associated with stroke-related dysphagia symptoms. Implementation of a coordinated swallow evaluation on all acute stroke patients has been shown to significantly decrease the incidence of pneumonia among patients with acute stroke. Adherence with use of a dysphagia screening tool for patients with acute stroke has been shown to be variable with up to 25% of patients not screened. When implemented, failing a dysphagia screen has been found to be a predictor of post-stroke pneumonia. Lack of standardized, high-quality tools has hampered implementation, and a review found only four of 35 protocols met basic quality criteria. Those four protocols included the Barnes Jewish Hospital Stroke Dysphagia Screen, the modified Mann Assessment of Swallowing Ability, the Emergency Physician Swallowing Screen and Toronto Bedside Swallowing Screen Test. Lack of consensus around the best tools to use has also led the Joint Commission to retire the dysphagia screen measure as a performance indicator for certification as a Primary Stroke Center.

Ischemic stroke; dysphagia; swallow screening

Number of all patients presenting with symptoms of acute ischemic stroke (see the related "Denominator Inclusions/Exclusions" field)

Number of patients who were screened for dysphagia before taking any food, fluids or medication (including aspirin) by mouth

Unspecified

Unspecified

Age greater than or equal to 18 years

The time frame pertaining to data collection is monthly.

Inclusions
Number of all patients presenting with symptoms of acute ischemic stroke

Population Definition: Patients age 18 years and older.

Exclusions
Unspecified

Inclusions
Number of patients who were screened for dysphagia before taking any food, fluids or medication (including aspirin) by mouth

Exclusions
Unspecified

Unspecified

Percentage of ischemic stroke patients who are assessed with a swallow screening test before receiving food, fluids or medications by mouth.

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Work Group Members: David Anderson, MD (Work Group Co-Leader) (University of Minnesota Physicians and Hennepin County Medical Center) (Neurology); David Larson, MD, FACEP (Work Group Co-Leader) (Ridgeview Medical Center) (Emergency Medicine); Gail Wallace, NP (Essentia Health) (Nursing); Lynne Fiscus, MD, MPH (Fairview Health Services) (Internal Medicine and Pediatrics); Andrew Zinkel, MD (HealthPartners Medical Group and Regions Hospital) (Emergency Medicine); Ron Charipar, MD (Marshfield Clinic) (Internal Medicine and Pediatrics); Alejandro Rabinstein, MD (Mayo Clinic) (Neurology); Jeff Larson, PharmD (Park Nicollet Health Services) (Pharmacy); Myounghee Hanson, BA (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator); Jim Bluhm, MPH (Institute for Clinical Systems Improvement) (Team Director)

David Anderson, MD (Work Group Leader)
Professor, Neurology Department, Neurology, University of Minnesota Physicians and Hennepin County Medical Center
National, Regional, Local Committee Affiliations: NNINDS NHLBI as an event adjudicator for two clinical trials: SAMMPRIS (Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke), and AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes)
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: MN Acute Stroke Systems Council, MDH and member of MN Time Critical Care Committee, MDH

Ron Charipar, MD (Work Group Member)
Professor, Internal Medicine, Marshfield Clinic
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Lynne Fiscus, MD, MPH (Work Group Member)
Internal Medicine and Pediatrics, Department, Fairview Health Services
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

David Larson, MD, FACEP (Work Group Member)
Medical Director, Ridgeview Emergency Department, Ridgeview Medical Center
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Clinical Advisory Panel Leader, TogetherMD, LLC, MN Acute Stroke Systems Council, MDH and member of MN Time Critical Care Committee, MDH

Jeff Larson, PharmD (Work Group Member)
Staff Pharmacist, Pharmacy, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Alejandro Rabinstein, MD (Work Group Member)
Professor, Neurology, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: Cardionet, MCOT use for an investigator-initiated project
Financial/Non-Financial Conflicts of Interest: Member of the Data Safety Monitoring Board for the PREVAIL study by ARTITECH (now Boston Scientific)

Gail Wallace, NP (Work Group Member)
Neurology Nurse Practitioner, Nursing, Essentia Health East Region
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Andrew Zinkel, MD (Work Group Member)
Section Head and Medical Director of Quality, Department of Emergency Medicine, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Clinical Advisory Panel Leader, TogetherMD, LLC

This measure was not adapted from another source.

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

The next scheduled revision will occur within 24 months.

This is the current release of the measure.

The individual measure, "Percentage of Ischemic Stroke Patients Who Are Assessed with a Swallow Screening Test Before Receiving Food, Fluids or Medications by Mouth," is published in "Health Care Guideline: Diagnosis and Initial Treatment of Ischemic Stroke." This document is available from the Institute for Clinical Systems Improvement (ICSI) Web site .

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web site: www.icsi.org ; e-mail: icsi.info@icsi.org.

This NQMC summary was completed by ECRI Institute on November 14, 2012.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

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