Authors: (including presenting author): :
Wong KW(1), Chan KW(2), Lo IOT (1), Wong R(2), Wan HYS(1), Fung SS(1), Wong LY(1), Ho KLC(1)
Affiliation: :
(1) Department of Cardiothoracic Surgery, Queen Mary Hospital, (2) Department of Speech Therapy, Queen Mary Hospital
Keyword 1: :
Swallowing Screening
Keyword 2: :
Post-extubation Dysphagia
Keyword 4: :
Cardiothoracic Surgery Intensive Care Unit
Keyword 6: :
Speech Therapist
Introduction: :
Post-extubation dysphagia (PED) is an established complication among patients in Cardiothoracic Surgery Intensive Care Unit (CTSICU), with reported incidence ranging from 5% to 50%, depending on patient demographics, surgical procedures, endotracheal intubation duration, screening modalities, and diagnostic criteria. PED is associated with significant adverse outcomes, including heightened aspiration risk, delayed recovery, and prolonged hospitalization. Early identification and proactive management of at-risk patients are essential for optimizing clinical outcomes; accordingly, a structured, multidisciplinary Nurse Swallowing Screening Protocol (NSSP) has been implemented in the CTSICU, Queen Mary Hospital (QMH).
Objectives: :
1. To develop and standardize the screening for PED in QMH CTSICU. 2. To systematize the workflow for timely referral and management of PED at-risk patients in QMH CTSICU. 3. To evaluate the effectiveness of the NSSP implemented between November 2023 and October 2025.
Methodology: :
In October 2023, the cardiothoracic surgeons, speech therapists and CTSICU nursing team at QMH co-developed the NSSP. The protocol comprises two parts to streamline the algorithm and criteria for conducting oral feeding screening: Part 1 involves patient chart review and physical assessment; Part 2 consists of oral trials with different consistencies. For patients failing in any component of NSSP, timely speech therapist referral will be arranged. To ensure procedural consistency and safety, nurses are required to complete a structured training and assessment bundle delivered by speech therapists prior performing the NSSP independently. The NSSP has been implemented in QMH CTSICU since November 2023.
Result & Outcome: :
Between November 2023 and October 2025, 62 CTSICU nurses completed the training and assessment bundle, and 1,305 patients underwent the NSSP. Of 339 patients flagged as at risk of PED in Part 1, 296 were confirmed dysphagic by speech therapists (positive predictive value [PPV]: 87.3%). Among the 966 patients who passed Part 1, 118 failed Part 2, of whom 101 were confirmed dysphagic (PPV: 85.6%). Including an additional 23 NSSP-passed patients who were subsequently diagnosed with dysphagia, there were 420 dysphagic cases in total (prevalence: 32.2%). The NSSP demonstrated a sensitivity of 94.5% (95% CI: 91.9-96.5%) in detecting PED against speech therapist bedside swallowing assessment. The NSSP provides CTSICU nurses with a consistent, safe and user-friendly framework for conducting oral feeding screening. It also specifies explicit speech therapist referral criteria to enable timely dysphagia management and complication mitigation. The excellent sensitivity (>94%) confirms its reliability as routine practice for identifying PED at-risk patients in the CTSICU setting.
