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Implementation of Post Extubation Dysphagia Risk Evaluation Tool in a Medical ICU
Dissertation   Open access

Implementation of Post Extubation Dysphagia Risk Evaluation Tool in a Medical ICU

Jessica R Stelle Swab
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Summer 2026
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Abstract

Background: Post-extubation dysphagia (PED) is common, underrecognized, and clinically significant in critically ill adults. Approximately one-third of mechanically ventilated ICU patients may experience dysphagia, and early screening studies have identified rates as high as 86% within the first hour after extubation. Dysphagia is associated with aspiration risk, delayed oral intake, and a 75% higher likelihood of reintubation. In the local MICU, 283 patients were intubated over 3 months, with a mean intubation duration of 3.5 days, highlighting a sizable at-risk population in a setting with inconsistent screening practices. Purpose: To implement and evaluate the Post-Extubation Dysphagia Screening Tool (PEDs-Tool) to standardize nurse-driven dysphagia risk screening in a 26-bed medical ICU and improve screening timeliness, optimize speech-language pathology (SLP) referral patterns, and increase nurse confidence. Methods: Guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care and the Iowa Implementation for Sustainability Framework, this evidence-based practice project implemented the nurse-administered PEDs-Tool in a 26-bed medical ICU at a Midwestern academic medical center. Eligible patients were adults intubated for 48 hours or longer without neurologic comorbidity or other exclusion criteria. Evaluation measures included screening within 6 hours of extubation, time to screening, SLP consultation rate and time to consultation, and nurse confidence measured on a 5-point Likert scale. Findings: Ninety-six eligible patients were included (pre n=36; post n=60). Screening within 6 hours increased from 46.88% to 74.29% (p=.001), and median time to screening decreased from 17.00 to 3.02 hours (p<.001). SLP consultation rates increased from 36.11% to 54.24% (p=.086), while time to consultation decreased significantly (median 4.30 vs 21.18 hours; p=.037). Nurse confidence improved significantly post-implementation (p=.001). Discussion: PEDs-Tool implementation improved screening timeliness, accelerated specialist evaluation, and increased nurse confidence, supporting safer post-extubation care and interdisciplinary coordination.
 Critical Care Post-extubation dysphagia dysphagia screening mechanical ventilation nurse-driven protocol

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