Elderly Patients 'Inhalation Prevention QI Program'Effective Re-admission Rate is 12x lower
Nov 11, 2024
A research team led by Kim Eun-sun, a general medicine professor at Bundang Seoul National University Hospital, has published the results of a study confirming the effectiveness of the 「QI (Quality Improvement)" program using the GUSS (Gugging Swallowing Screen)" in elderly patients at high risk of aspiration pneumonia hospitalized for acute medical diseases.
Aspiration pneumonia is caused by food and saliva entering the airways incorrectly and is very fatal to elderly patients.
As aging progresses, swallowing disorders are common, and the risk of aspiration increases. In particular, a significant number of elderly patients hospitalized for acute medical conditions already have risk factors for aspiration, and because treatment is difficult and recurrence is highly likely, it is very important to check for aspiration at the right time and to educate about proper dietary progression.
Methods used to check for aspiration include VFSS (Video Fluroscopy Study) and GUSS. VFSS is a test that examines the swallowing process of food by examining the swallowing process. This takes a considerable amount of time to request, perform, and finally confirm the inspection, and requires radiation exposure and expensive costs. If the patient's condition is not cooperative for the implementation of VFSS, the test is virtually impossible.
The GUSS test is a screening test that evaluates aspiration disorders in four stages. It is a non-invasive method of evaluating saliva swallowing, drooling, voice changes, cough or phlegm removal behavior, and observing diet, and can quickly and easily evaluate aspiration in hospital beds. However, this test has been widely used only as a tool to check for swallowing disorders in stroke patients, and no studies have been conducted on whether it can be used as a useful tool for patients with acute internal diseases.
In response, Professor Kim Eun-sun of the Department of General Medicine at Seoul National University Bundang Hospital tried to develop a 'Absmust Prevention QI' program that identifies patients with high risk of aspiration using GUSS in patients with acute internal medicine disease and provides personalized dietary and rehabilitation education for them, and to confirm their clinical effectiveness.
The research team implemented the aspiration prevention QI program in 96 elderly patients over 65 years of age who were admitted to Bundang Seoul National University Hospital with acute medical conditions from April 2021 to March 2023. By matching them with 96 people who did not participate in the program, the effectiveness of the aspiration prevention QI program was analyzed by comparing fasting period, nutritional status, hospital mortality, and hospitalization rate due to pneumonia within 90 days.
The study found that the patient group who participated in the program showed no significant difference in fasting period, nutritional status, number of hospitalization days, and in-hospital mortality compared to the patient group who did not participate in the aspiration prevention QI program, but the probability of being readmitted due to pneumonia within 90 days was approximately 12 times higher in the patient group who did not participate in the aspiration prevention QI program.
The results of this study are significant as they suggest that GUSS testing in hospitalized patients with acute internal medical conditions can provide objective data to complement the subjective judgment of medical staff, and the aspiration prevention QI program based on this can be used as an alternative to overcome the limitations of VFSS.
Kim Eun-sun, a general medicine professor at Seoul National University Bundang Hospital, said "This study has played an important role in improving the quality of life of elderly patients and improving the efficiency of the healthcare system by presenting a new criterion for preventing aspiration pneumonia in acute-stage internal medicine disease" and will evaluate how the GUSS program can be applied in various clinical situations and verify the long-term effects of the program through further research" the study plan.
The paper was recently published in the international academic journal 'Clinical Interventions in Aging'.
Aspiration pneumonia is caused by food and saliva entering the airways incorrectly and is very fatal to elderly patients.
As aging progresses, swallowing disorders are common, and the risk of aspiration increases. In particular, a significant number of elderly patients hospitalized for acute medical conditions already have risk factors for aspiration, and because treatment is difficult and recurrence is highly likely, it is very important to check for aspiration at the right time and to educate about proper dietary progression.
Methods used to check for aspiration include VFSS (Video Fluroscopy Study) and GUSS. VFSS is a test that examines the swallowing process of food by examining the swallowing process. This takes a considerable amount of time to request, perform, and finally confirm the inspection, and requires radiation exposure and expensive costs. If the patient's condition is not cooperative for the implementation of VFSS, the test is virtually impossible.
The GUSS test is a screening test that evaluates aspiration disorders in four stages. It is a non-invasive method of evaluating saliva swallowing, drooling, voice changes, cough or phlegm removal behavior, and observing diet, and can quickly and easily evaluate aspiration in hospital beds. However, this test has been widely used only as a tool to check for swallowing disorders in stroke patients, and no studies have been conducted on whether it can be used as a useful tool for patients with acute internal diseases.
In response, Professor Kim Eun-sun of the Department of General Medicine at Seoul National University Bundang Hospital tried to develop a 'Absmust Prevention QI' program that identifies patients with high risk of aspiration using GUSS in patients with acute internal medicine disease and provides personalized dietary and rehabilitation education for them, and to confirm their clinical effectiveness.
The research team implemented the aspiration prevention QI program in 96 elderly patients over 65 years of age who were admitted to Bundang Seoul National University Hospital with acute medical conditions from April 2021 to March 2023. By matching them with 96 people who did not participate in the program, the effectiveness of the aspiration prevention QI program was analyzed by comparing fasting period, nutritional status, hospital mortality, and hospitalization rate due to pneumonia within 90 days.
The study found that the patient group who participated in the program showed no significant difference in fasting period, nutritional status, number of hospitalization days, and in-hospital mortality compared to the patient group who did not participate in the aspiration prevention QI program, but the probability of being readmitted due to pneumonia within 90 days was approximately 12 times higher in the patient group who did not participate in the aspiration prevention QI program.
The results of this study are significant as they suggest that GUSS testing in hospitalized patients with acute internal medical conditions can provide objective data to complement the subjective judgment of medical staff, and the aspiration prevention QI program based on this can be used as an alternative to overcome the limitations of VFSS.
Kim Eun-sun, a general medicine professor at Seoul National University Bundang Hospital, said "This study has played an important role in improving the quality of life of elderly patients and improving the efficiency of the healthcare system by presenting a new criterion for preventing aspiration pneumonia in acute-stage internal medicine disease" and will evaluate how the GUSS program can be applied in various clinical situations and verify the long-term effects of the program through further research" the study plan.
The paper was recently published in the international academic journal 'Clinical Interventions in Aging'.
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