Authors (including presenting author) :
Yeung HT(1), Chan OT(1), Fung KY(1), Yu YN(1), Wan TK(1), Lao WY(2), Lee SY(1)
Affiliation :
(1)Intensive Care Unit, Caritas Medical Centre (2)Multi-disciplinary Simulation Training Centre, Kwong Wah Hospital
Keyword 3: :
Post-extubation
Introduction :
Post-extubation dysphagia (PED) affects about 41% of ICU patients undergoing endotracheal intubation for mechanical ventilation. Data retrieved from October 2024 to January 2025 shown that only 63.4% of extubated patients underwent a water swallowing test (WST) before oral intake, causing a 15.1-hour delay in assessments and diet resumption. Staff survey further revealed inconsistencies in WST procedures, trial numbers, water volumes, and timing, prompting a pilot study for a standardized protocol.
Objectives :
- To standardize the assessment tool in identifying patients at risk of PED
- To shorten the lag time of resuming diet for post-extubation patients
Methodology :
The Yale Swallow Protocol (YSP), an evidence-based screening tool for PED, was adapted. Prior to rollout, consultations were held with doctors and Speech Therapist (ST) to refine the protocol and further modified the YSP as The Modified Yale Swallow Protocol (MYSP).
The pilot study conducted in January-May 2025 employed a pre-post implementation design. ST led the train-the-trainer programme to verify the team as trainers. Through seven identical face-to-face training sessions by the team, achieving 100% coverage, nurses were equipped with essential knowledge regarding PED screening and passed scenario-based skill assessment. On-site spot audits, random sampling checks and blinded cross-verification by ST were done to aid continuous improvement in compliance and patient safety.
Result & Outcome :
1. Patient outcome
The mean time from extubation to WST initiation was reduced by 40%. The extubation-to-diet time decreased by 23%. Time gap required for identification of high-PED risk patients improved significantly, with 72.5% reduction in referral delays and 71.4% shorter time to ST assessment. 33.3% patients referred to ST were confirmed with dysphagia. No patients who passed MYSP required subsequent ST referral during ICU stay. Data cross-checked with ST has identified two true positives and one false negative result.
2. Staff outcome
Nurses’ compliance with WST/MYSP before oral intake improved from 63.4% to 96%. In the post education-training test, nearly all staff could accurately identify aspiration signs and MYSP failing criteria, while 92% could answer scenario questions correctly. All respondents agreed they understood their roles & responsibilities, and appropriate actions when aspiration symptoms were observed, ensuring enhanced patient safety.
