BACKGROUND Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary. METHODS We carried out a criteria-based clinical audit (CBCA) in a small stroke unit at a Norwegian hospital. Patients with hemorrhagic stroke, ischemic stroke and transient ischemic attack were included. A power calculation informed the number of included patients at baseline (n = 80) and at re-audit (n = 35). We compared the baseline result with the evidence-based criteria and gave feedback to management and staff. A brainstorming session, a root-cause analysis and implementation science were used to inform the quality improvement actions which consisted of workshops, use of local opinion leaders, manual paper reminders and feedback. We completed a re-audit after implementation. Percentages and median are reported with 95% confidence intervals (CI). RESULTS Among 88 cases at baseline, documentation of swallow screening was complete for 6% (95% CI 2-11). In the re-audit (n = 51) 61% (95% CI 45-74) had a complete screening. CONCLUSION A CBCA involving management and staff, and using multiple tailored intervention targeting barriers, led to greater adherence with the recommendation for screening stroke patients for dysphagia.

中文翻译：

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急性中风后吞咽困难筛查：使用基于标准的临床审核的质量改善项目。

背景技术吞咽困难在中风后很常见，并且是发展为吸入性肺炎的主要危险因素。早期发现可以减少发生肺部并发症和死亡的风险。尽管基于证据的指南建议使用标准化的筛查工具筛查吞咽缺陷，但国家审计已发现实践与该建议之间存在差距。目的是确定对基于证据的吞咽评估建议的遵守程度，并在必要时采取措施改善实践。方法我们在一家挪威医院的小卒中病房进行了基于标准的临床审核（CBCA）。包括出血性中风，缺血性中风和短暂性脑缺血发作的患者。功效计算告知基线（n = 80）和再次审核（n = 35）时纳入患者的数量。我们将基线结果与基于证据的标准进行了比较，并向管理层和员工提供了反馈。通过头脑风暴会议，根本原因分析和实施科学，为质量改进行动提供了信息，包括研讨会，当地舆论领袖的使用，手工纸质提醒和反馈。实施后，我们完成了重新审核。报告的百分比和中位数具有95％的置信区间（CI）。结果在基线的88例患者中，吞咽筛查的文件完整率为6％（95％CI 2-11）。在重新审核（n = 51）中，有61％（95％CI 45-74）进行了全面筛查。结论CBCA涉及管理层和员工，并使用针对性障碍的多种量身定制的干预措施，