Appendix Table 1.
Inclusion Rates of Specific Dysphagia Recommendations (Recs) Made by Speech-Language Pathologists (SLP) for Stroke and Hip Fracture Patients Discharged to Sub-Acute Care Facilitiesa, b (N=187)
| Discharge Summary |
||||
|---|---|---|---|---|
| Specific Dysphagia Recommendations Made by SLPs | Prevalence of Recs in Final SLP Hospital Chart Note (Total N=187) % (n) |
Prevalence of Recs in Discharge Summary (Total N=187) % (n) |
Number of SLP Recs Accurately Included in Discharge Summary (n) |
Number of Recs Included in Discharge Summary NOT Originating From SLP Note (n) |
| Food recommendations | ||||
| General/normal/regular diet | 31% (58) | 8% (15) | 12 | 3 |
| Mechanical soft diet/chopped/diced | 34% (63) | 19% (36) | 26 | 10 |
| Mechanical soft dysphagia diet | 11% (21) | 3% (5) | 3 | 2 |
| Ground/crushed/minced food | 0% (0) | 0% (0) | 0 | 0 |
| Pureed diet/semisolid diet | 17% (32) | 15% (28) | 18 | 10 |
| Moist food products/add gravy, sauces, condiments | 1% (1) | 0% (0) | 0 | 0 |
| Allow special/specific food that patient enjoys | 1% (2) | 0% (0) | 0 | 0 |
| Food restrictions | ||||
| No foods with mixed consistencies (i.e., fruit cocktail, etc.) | 1% (1) | 0% (0) | 0 | 0 |
| Food restriction NOS | 1% (1) | 0% (0) | 0 | 0 |
| Foods and liquids that stimulate sensation | ||||
| Foods with intense flavor | 1% (2) | 1% (1) | 1 | 0 |
| Favorite foods | 1% (2) | 1% (1) | 0 | 1 |
| Favor hot or cold foods/no room-temperature foods | 2% (3) | 1% (2) | 2 | 0 |
| Nectar-thick liquids | 24% (44) | 11% (21) | 20 | 1 |
| Honey-thick liquids | 3% (6) | 4% (7) | 6 | 1 |
| Pudding-thick liquids | 0% (0) | 1% (1) | 0 | 1 |
| No liquids | 2% (4) | 1% (1) | 0 | 1 |
| Liquids by spoon only | 2% (3) | 0% (0) | 0 | 0 |
| Liquids by cup only | 1% (1) | 0% (0) | 0 | 0 |
| Liquids by straw only | 1% (1) | 0% (0) | 0 | 0 |
| No liquids by cup | 1% (1) | 0% (0) | 0 | 0 |
| Dietary supplements | 5% (9) | 0% (0) | 0 | 0 |
| Alternative means of nutrition | 4% (7) | 0% (0) | 0 | 0 |
| Feeding for oral gratification | 1% (1) | 0% (0) | 0 | 0 |
| Tube feeding | ||||
| Nasogastric tube | 3% (5) | 1% (2) | 2 | 0 |
| Gastrostomy tube | 6% (11) | 5% (10) | 6 | 4 |
| 90-degree angle/upright posture during consumption | 45% (85) | 8% (15) | 11 | 4 |
| 90-degree angle/upright posture after consumption | 9% (17) | 4% (7) | 2 | 5 |
| Head adjustments | ||||
| Chin tuck | 18% (33) | 5% (9) | 8 | 1 |
| Rotate head to left/right while eating | 6% (11) | 1% (2) | 2 | 0 |
| Present bolus to left/right side of mouth | 5% (10) | 0% (0) | 0 | 0 |
| Lingual or finger sweep on left/right side of mouth | 2% (4) | 0% (0) | 0 | 0 |
| Effortful swallow during meals | 3% (6) | 0% (0) | 0 | 0 |
| Multiple swallows per bite | 12% (23) | 1% (2) | 2 | 0 |
| Try to improve timing of swallow | 2% (3) | 0% (0) | 0 | 0 |
| Tongue protrusion exercises | 3% (5) | 0% (0) | 0 | 0 |
| Tongue lateralization exercises | 2% (3) | 0% (0) | 0 | 0 |
| Tongue hold and swallow exercises | 1% (1) | 0% (0) | 0 | 0 |
| NOS tongue exercise | 2% (3) | 0% (0) | 0 | 0 |
| Lip protrusion/retraction exercise | 2% (4) | 0% (0) | 0 | 0 |
| Laryngeal elevation/falsetto techniques | 2% (3) | 0% (0) | 0 | 0 |
| Vocal fold adduction exercises | 1% (1) | 0% (0) | 0 | 0 |
| Speech/talking exercises | 1% (2) | 0% (0) | 0 | 0 |
| Effortful swallow exercise | 2% (4) | 0% (0) | 0 | 0 |
| Yawning exercises | 1% (1) | 0% (0) | 0 | 0 |
| Procedural and sizing recommendations | ||||
| Alternate solids and liquids | 8% (15) | 1% (2) | 2 | 0 |
| Half-teaspoon/teaspoon bolus size | 7% (14) | 1% (1) | 0 | 1 |
| Small bites/sips | 25% (47) | 3% (5) | 2 | 3 |
| Eat slowly | 19% (36) | 2% (3) | 2 | 1 |
| Medications - Pill recommendations | ||||
| Crush/split/grind/chop pills | 11% (21) | 2% (3) | 1 | 2 |
| Take pill with puree (i.e., applesauce) | 5% (10) | 1% (2) | 1 | 1 |
| Supervision, monitoring and assistance | ||||
| One to one supervision | 11% (20) | 3% (5) | 2 | 3 |
| Periodic supervision | 1% (2) | 0% (0) | 0 | 0 |
| NOS supervision | 6% (11) | 2% (3) | 1 | 2 |
| One to one feeding assistance | 10% (18) | 5% (10) | 3 | 7 |
| NOS feeding assistance | 11% (21) | 1% (2) | 2 | 0 |
| Monitor for signs/symptoms of aspiration | 13% (24) | 3% (5) | 1 | 4 |
| Monitor for oral pocketing on left/right side | 5% (9) | 1% (2) | 0 | 2 |
| Monitoring NOS | 9% (16) | 1% (2) | 0 | 2 |
| Swallowing only to be performed in presence of an SLP/MD | 3% (5) | 1% (1) | 1 | 0 |
| Advance diet as tolerated | 6% (11) | 2% (4) | 0 | 4 |
| Discontinue feedings at a future date | 4% (8) | 0% (0) | 0 | 0 |
| Oral care | 1% (2) | 0% (0) | 0 | 0 |
| Food on left/right side of tray | 2% (4) | 0% (0) | 0 | 0 |
| Encourage independence with eating | 2% (3) | 0% (0) | 0 | 0 |
| Follow-up evaluation by SLP needed | 13% (24) | 1% (2) | 0 | 2 |
| Follow-up evaluation by a non-SLP needed | 4% (8) | 1% (1) | 0 | 1 |
a
SLP = Speech-Language Pathologist; Recs = Recommendations; NOS = Not otherwise specified
b
Recommendations that were not included in any SLP hospital chart notes or discharge summaries are omitted