Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Diane Chlebowy

Committee Member

Beverly Williams-Coleman

Author's Keywords

quality improvement, QI, stroke, TORBSST, swallow study, dysphagia, emergency department, ED, aspiration, nursing education, swallow screening.


Stroke is the 5th leading cause of death when isolated from other cardiovascular diseases in the United States (U.S.) (CDC, 2017). The Centers for Disease and Control (CDC) indicated that 795,000 people have a stroke each year with 65% suffering from some form of dysphagia, or difficulty swallowing. Implementing a simple screening by a trained nurse can detect dysphagia and prevent adverse outcomes, such as aspiration. In the emergency department (ED) of a suburban acute care facility, a pattern of inconsistent Toronto Bedside Swallow Screening Tool (TORBSST) was noted for 24 consecutive months. The purpose of this quality improvement (QI) project was to improve nursing knowledge, implementation, and documentation of the TORBSST prior to by mouth (PO) medication, food, and/or fluid administration. Three 15-minute education sessions followed by daily practice reminders in relation to TORBSST implementation and documentation through shift huddles and flyers were implemented. Baseline nursing knowledge was evaluated with a self-designed assessment administered before and two-months post presentation. No changes in mean knowledge scores were identified. Patient care outcomes data were obtained from the electronic health record for 2-months before and following the intervention. A 100% pre- and post-test accuracy response indicates that knowledge did not impact TORBSST implementation and documentation. Initiation of intentional reminders in conjunction with continual rewarding reinforced expected outcomes and improved TORBSST implementation and documentation. Future implications should include expanded observation and follow up time frames at multiple sites with a larger sample size. Annual nursing education in regard to TORBSST implementation and documentation policy and procedure should be considered for establishment and evaluation.

Included in

Nursing Commons