Decision Guide Clarifies Indicators for Swallowing Consults

Feb 01, 2023

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Article in Critical Care Nurse details how ECU Health Medical Center in North Carolina developed a clear process for determining which recently extubated patients required referrals for swallowing evaluations

ALISO VIEJO, Calif. – Feb. 1, 2023 – A multidisciplinary group at ECU Health Medical Center in Greenville, North Carolina, developed a decision guide to provide healthcare teams with specific guidelines for swallowing care after extubation. The decision guide standardizes the process for clinicians to determine which recently extubated patients required further swallowing assessment by an appropriate professional.

As the only Level 1 trauma center east of Raleigh, North Carolina, ECU Health Medical Center serves a vast rural region home to more than 1.4 million people and is the largest resource for critically ill patients in eastern North Carolina. Critically ill patients are frequently intubated with an endotracheal tube to maintain an adequate airway for breathing. After the endotracheal tube is removed, patients often experience difficulty swallowing, also known as dysphagia, which is associated with a variety of poor outcomes.

"It is important that patients experiencing dysphagia be treated swiftly because dysphagia can cause difficulty eating, drinking or swallowing necessary medications," said Waverlyn J. Royals, MS, CCC-SLP, speech-language pathology (SLP) clinical specialist and student education coordinator for rehabilitation services at ECU Health Medical Center. "Determining which patients need a swallowing assessment helps care teams intervene early and improve outcomes, as well as more efficiently use resources and reduce costs."

Since ECU Health is an academic health system, its partnership with Brody School of Medicine at East Carolina University allows for team members such as Royals to conduct research to continue finding best practices for patients and care teams. The multidisciplinary group conducted a literature review as part of a process improvement project to help clarify decision-making for patients post-extubation. This review identified specific risk factors that healthcare teams should consider regarding dysphagia post-extubation.

These risk factors became points of decision in the guide. A "yes" answer to any of the decision points resulted in the patient's continued non-oral status and triggered a consult to SLP professionals. If each question has a "no" response, it eliminates unnecessary requests to assess patients who already tolerate an oral diet. For patients with no positive indicators from the decision guide, including a water swallowing challenge, the nurse consulted with a healthcare provider about starting an oral diet.

"In addition to clarifying which patients need further evaluation, the guide provides nurses and providers with clear indicators to answer questions from patients and families about why individuals were deemed unready to safely resume eating and drinking," Royals said.

"A Decision Guide for Assessing the Recently Extubated Patient's Readiness for Safe Oral Intake" details the development of the guide, as well as the risk factors and clinical indicators it covers. The study is published in the February issue of Critical Care Nurse (CCN).

As the American Association of Critical-Care Nurses' bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 128,000 and can be accessed at

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