Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy-eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran-Armitage test ). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening. 1. Introduction A well-established best practice in the care of patients with stroke is the early detection of dysphagia as it allows for immediate intervention thereby reducing morbidity, length of stay, and healthcare costs [1–3]. The essential first step to ensure early detection of dysphagia, and to prevent dysphagia-related morbidity, is to screen all stroke patients for signs of swallowing impairment prior to oral intake [1]. When a swallowing screening protocol is implemented, there is a decrease in morbidity over each year that the protocol is in place [4]. Moreover, when hospitals implement a formal swallowing screening protocol for patients with stroke, there is improvement in clinicians’ adherence with screening swallowing prior to oral intake [2], and the first dose of aspirin is administered earlier [5]. These findings have led the American Heart Association/American Stroke Association (AHA/ASA) to include screening of swallowing prior to the administration of food, liquid, or medication in individuals presenting with stroke symptoms as part of their guidelines on the early management of adults with acute stroke [6]. Within the Veterans Health Administration (VHA) the importance of dysphagia screening in patient with stroke is reflected in the issuance of
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