Role of the Speech-Language Pathologist in the Neurology inpatient clinic at a - ESSD2018

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INTRODUCTION 
 
In hospital environments, dysphagia is related to longer hospitalization 
periods, higher hospital costs and higher mortality risk¹. Dysphagia can 
lead to social isolation, dehydration, malnutrition and aspiration 
pneumonia, and may even lead to death². 
 
Public disclosure of hospital performance through quality indicators is 
encouraged to promote transparency and increase the accountability of 
the service regarding health care quality³,4	
  
 
The objective of the present study was to analyze and compare the quality 
of management of dysphagia in the Nursing of Neurology of a university 
hospital, in periods with and without Speech-Language Pathologist (SLP).	
  
 
 
 
Role of the Speech-Language Pathologist in the Neurology inpatient clinic at a 
Teaching Hospital in Brazil 
Felippe, B.S1; Lima DP1, Mourão, LF.1 
1 University of Campinas, Brazil. 
Contact: lumourao@fcm.unicamp.br 
 
Identifier/Topic: Professional Roles in Dysphagia Management 
 
REFERENCES 
 
1. Altman, K. W. (2011). Dysphagia evaluation and care in the hospital setting: the need for protocolization. Otolaryngology--Head and Neck Surgery, 145(6), 895-898. 
2. Boccardi, V., Ruggiero, C., Patriti, A., Marano, L. (2016). Diagnostic assessment and management of dysphagia in patients with Alzheimer’s disease. J Alzheimers Dis., 
50(4):947–955. 
3. Frain, M.P., Tschopp, M.K., Bishop, M (2009). Empowerement Variables as Predictors of Outcomes in Rehabilitation. J Rehabil.;75(1):27-35. 
4. Glickman, S.W., Schulman, K.A., Peterson, E.D., Hocker, M.B., & Cairns, C.B. (2008). Evidence-based perspectives on pay for performance and quality of patient care 
and outcomes in emergency medicine. Annals of emergency medicine, 51(5), 622-631 
5. Wieseke, A., Bantz, D., Siktberg, L., & Dillard, N. (2008). Assessment and early diagnosis of dysphagia. Geriatric Nursing, 29(6), 376-383. 
6. White, G.N., O'Rourke, F., Ong, B.S., Cordato, D.J., & Chan, D.K. (2008). Dysphagia: causes, assessment, treatment, and management. Geriatrics, 63(5). 
MATERIAL AND METHODS 
 
This is a retrospective, quantitative and longitudinal study. 
 
Information were collected from medical records of neurology inpatients in 
two periods: with and without the presence of a Speech-Language 
Pathologist (SLP) in the multidisciplinary team. 
 
We included adult and elderly patients hospitalized in the Clinical Neurology 
and who were referred for swallowing screening by the nursing team and 
medical staff. 
 
Data such as age, gender, hospitalization diagnosis, use of ventilation 
support (mechanical ventilation, orotracheal intubation or tracheostomy), 
previous comorbidities, clinical complications, length of stay, time for 
requesting swallowing evaluation, time for introduction and removal of the 
enteral tube feeding, time for the introduction of oral feeding, 
bronchoaspiration events, were collected. The comparison between the 
groups was performed using the Mann-Whitney statistical test with a 
significance level of 5% (p<0.05). 
RESULTS 
 
Out of 245 medical records analyzed, 175 were adequate to the method and 
included in the study. 
 
In the period with the SLP, when compared to the period without a 
pathologist, there was a reduction on the time taken to introduce the enteral 
tube feeding, time of removal of the alternative method, time taken to 
request a swallowing evaluation and time to return to oral feeding. 
 
The time using the enteral tube feeding was reduced in almost half with the 
presence of the SLP, however, the length of stay time was longer. 
 
 
CONCLUSION 
 
We can claim that the presence of the professional specialist in Dysphagia, 
the SLP, in a teaching hospital, contributes to the improvement of quality 
indicators in dysphagia management. Reinforcing the importance of this 
professional in the evaluation and rehabilitation of swallowing of inpatients, 
minimizing clinical complications and contributing to a safer dysphagia 
management. 
 
Variables 
Period 
____________________________________ 
With SLP Without SLP 
 (µ) SD (Min-Max) (µ) SD (Min-Max) 
 
p-value 
Length of stay 23.02 SD 26.8 (0-157) 17.02 SD 22.4 (1-150) 0.045* 
Time for introduction of 
ETF 
 3.01 SD 6.44 (0-45) 3.50 SD 4.91 (1-24) 0.014* 
Time for removal of ETF 16.6 SD 20.69 (1-116) 27.11 SD 29.04 (4-111) 0.034* 
Time for requesting 
swallowing evaluation 
10.10 SD 17.94 (0-123) 27.00 SD 16.86 (1-150) 0.073* 
Time for introduction of 
OF 
 12.38 SD 9.23 (1-45) 12.67 SD 5.68 (8-19) 0.761 
Age 48.62 SD 16.89 (18-81) 50.5 SD 17.77 (19-98) 0.507 
Gender 1.48 SD 0.503 (1-2) 1.45 SD 0.501 (1-2) 0.695 
Number of comorbidities 0.52 SD 0.881 (0-3) 0.90 SD 1.117 (0-3) 0.020* 
Clinical complications 1.39 SD 0.491 (1-2) 1.26 SD 0.439 (1-2) 0.053 
Ventilation support 1.30 SD 0.462 (1-2) 1.30 SD 0.462 (1-2) 0.988 
Diet 3.7 SD 1.13 (1-5) 2.66 SD 1.68 (1-5) 0.001* 
Table 2 – Comparison of indicators and clinical parameters between periods with and without a Speech-Language 
Pathologist. 
Caption: N = total number; µ = MEAN; SD = standart deviation; Min = Minimum; Max = Maximum. 
*significance level adopted 0.05 
 
Variables 
With SLP 
(n=89) 
N (%) 
Without SLP 
(n=86) 
N (%) 
Age 18 to 20 years 
20 to 59 years 
60 years or older 
3 (3,37%) 
59 (66,2%) 
27 (30,3%) 
5 (5,81%) 
53 (59,3%) 
30 (34,8%) 
Gender 1 – Male 
2 – Female 
46 (48,3%) 
43 (51,7%) 
47 (54,7%) 
39 (45,3%) 
Comorbidities 0 
1 
2 
>3 
63 (70,8%) 
9 (10,1%) 
14 (15,7%) 
3 (3,4%) 
48 (55,8%) 
9 (10,5%) 
19 (22,1%) 
10 (11,6%) 
Neurological disorders 1 – Vascular 
2 – Muscle 
3 – Demyelinating 
4 – Degenerative 
5 – Neoplastic 
6 – Syndromes 
7 – Others 
34 (38,2%) 
13 (14,6%) 
6 (6,7%) 
8 (9,0%) 
4 (4,5%) 
12 (13,5%) 
10 (11,2%) 
30 (34,9%) 
7 (8,1%) 
11 (12,8%) 
7 (8,1%0 
3 (3,5%) 
23 (26,7%) 
5 (5,8%) 
Ventilation support 1 – Absent 
2 – Present 
62 (69,7%) 
27 (30,3%) 
60 (69,8%) 
26 (30,2%) 
Enteral tube feeding 
(ETF) 
1 – Absent 
2 – Present 
72 (80,9%) 
17 (19,1%) 
50 (58,1%) 
36 (41,9%) 
Clinical complications 1 – Absent 
2 – Present 
54 (60,7%) 
35 (39,3%) 
64 (74,4%) 
22 (25,6%) 
Diet 1 – General 
2 – Light 
3 – Pureed 
4 – Slightly Mixed 
5 - Enteral 
6 (6,7%) 
6 (6,7%) 
19 (21,3%) 
35 (39,3%) 
23 (25,8%) 
36 (41,8%) 
0 (0,0%) 
10 (11,6%) 
14 (16,2%) 
16 (18,6%) 
Pulmonary aspirations 17 (19,1%) 10 (11,6%) 
Table 1 – Characteristics of the sample studied in the periods with and without a Speech-Language Pathologist. 
Caption: N = total number; % = percentage; F = female; M = male; 0 = no comorbidity; 1 = one comorbidity; 2 = two comorbidities; >3 = 
three or more comorbidities. 
DISCUSSION 
 
Literature points that shorter swallowing rehabilitation periods and faster 
return to oral feeding (OF) result in lower costs for beds in intensive care 
units and inpatient unit, medication, enteral diet, tests and materials for 
procedures, which reinforces the use of indicators of time to reintroduce oral 
feeding and time for removal of the enteral tube feeding (ETF)5. These 
indicators are good parameters to infer the actions of the multiprofessional 
team on the reduction of risk-consequence of dysphagia6. 
ACKNOWLEDGMENTS 
 
We would like to thank the Fundação de Amparo à Pesquisa do Estado de São Paulo 
(FAPESP- Brazil) for the financial and institutional support (Case no. 2017/01944-3). 
7--5F
Daniella Lima DOI: 10.3252/pso.eu.ESSD2018.2018
Session 05. Poster session 5F: Professional Roles in Dysphagia Management 1