Poster Presentation Australian and New Zealand Stroke Organisation Conference 2026

Improving dysphagia screening for acute stroke – a multi-site quality improvement initiative  (#123)

Rachel Levine 1 2 3 , Paul Blee 2 4 , Aylissa Canning 4 5 , Andrew Wong 4 6 7
  1. Speech Pathology & Audiology, Surgical Treatment and Rehabilitation Service (STARS), Metro North Health, Brisbane, QLD, Australia
  2. Healthcare Improvement Unit, Clinical Excellence Queensland, Department of Health, Brisbane, QLD, Australia
  3. School of Health & Rehabilitation Sciences, Health, Medicine & Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
  4. Queensland Stroke Clinical Network, Clinical Excellence Queensland, Department of Health, Brisbane, QLD, Australia
  5. eHealth, Clinical Excellence Queensland, Department of Health, Brisbane, QLD, Australia
  6. Neurology & Stroke Department, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, QLD, Australia
  7. The Frazer Institute, The University of Queensland, Brisbane, QLD, Australia

Background/aims: Post-stroke dysphagia leads to debilitating complications including malnutrition, dehydration and pneumonia, impacting length of hospital stay, stroke recovery and mortality(1, 2). Early screening and assessment for dysphagia is recommended to reduce the risk of complications(3,4). However, rates of screening in Queensland are below national benchmarks in the face of several reported barriers. This quality improvement initiative aimed to develop scalable, sustainable solutions to improve dysphagia screening in Queensland Health hospitals. 

Methods: We adopted an exploratory sequential mixed-methods design involving co-design and a pilot evaluation. Benchmarking, a project working group and stakeholder engagement informed current practice, available resources and barriers and enablers to dysphagia screening. Barriers and enablers were mapped to the COM-B model(5). Evidence-based strategies to overcome barriers were then identified(6) and co-developed with clinicians to develop an online change management toolkit, change champion approach and promotional communications, addressing gaps in training, awareness, motivation and procedures. The online toolkit is planned for evaluation via a 3-month pilot with a small sample of sites with representatives on the working group, prior to statewide roll-out. Outcomes of interest include clinician perspectives on resources, perceived knowledge and skills in screening and rates of dysphagia screening.  

Results: evaluation is currently underway, for completion by June 2026. 

Conclusion: This project leveraged local expertise to identify evidence-based strategies to improve dysphagia screening in stroke. The change management toolkit will build clinician capacity to drive locally tailored improvement initiatives. Future evaluation of the sustainment of the toolkit and its impact on screening outcomes is required.   

  1. Altman KW, Yu G-P, Schaefer SD. Consequence of Dysphagia in the Hospitalized Patient: Impact on Prognosis and Hospital Resources. Archives of otolaryngology--head & neck surgery. 2010;136(8):784-9.
  2. Banda KJ, Chu H, Kang XL, Liu D, Pien L-C, Jen H-J, et al. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC geriatrics. 2022;22(1):420-10.
  3. Stroke Foundation. Living clinical guidelines for stroke management 2026. [Available from: https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management#]
  4. Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L, et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of neurology, neurosurgery and psychiatry. 2017;88(1):25-30.
  5. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
  6. Johnston M, Carey RN, Connell Bohlen LE, Johnston DW, Rothman AJ, de Bruin M, et al. Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus. Translational behavioral medicine. 2021;11(5):1049-65.