What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

• Difficulty swallowing (dysphagia) affects approximately 50% of patients post-stroke and 62% of critical care patients.
• Serious health consequences associated with dysphagia include malnutrition, dehydration, aspiration pneumonia, mortality, 40% longer length of stay (LOS) in hospital and reduced quality of life.
• Patients with sensory swallowing deficits are difficult to rehabilitate using existing treatment options; often requiring longer-term, extensive SLT/MDT input to manage their dysphagia.
• We aim to introduce active treatment for this patient cohort with a pioneering sensory dysphagia treatment called Phagenyx.
• This evidence-based treatment has seen unprecedented improvements in swallowing sensation, resulting in faster recovery of the swallowing problem, quicker return to oral intake, fewer dysphagia related medical complications, reduced need for medical interventions and LOS and enhanced quality of life.
• Timely dysphagia management provides significant economic benefits within the hospital system and community SLT service. ICU bed day costs approximately £1200 compared to £400 for a medical bed.

What does your project aim to achieve?

This treatment is recognised as safe and effective and has been adopted in two NI hospitals to date. In NHSCT we too wish to become a leading centre for dysphagia excellence.

Extensive research has shown that Phagenyx® is associated with significant improvement of dysphagia and a reduction in length of hospital stay. Post-treatment, patients have demonstrated a safer swallow, progressed to greater oral diet, could be decannulated sooner, had their feeding tube removed and progressed quicker to discharge home (Bath et al., 2020; Dziewas et al., 2018)

Without this treatment, this patient population remain challenging to rehabilitate. Their swallow impairment does not benefit from traditional therapy, and they often remain long-term NBM. Our goal is to ensure that patients who would benefit from the treatment have rapid access to it, to maximise their quality of life and rehabilitation outcomes thus reducing the need for longer term SLT/MDT input.

How will the project be delivered?

By redesigning the care pathway for patients with sensory dysphagia and adopting this new treatment, we will receive training from the company which will maximise staff competency and understanding. Nursing staff, consultants, AHPs and relevant stakeholders will all receive training to understand the treatment and its benefits.  Engaging Service users will also provide essential feedback and identify how best to communicate these changes.

Incorporating the treatment into our toolkit will allow patients who previously would have had very limited suitable intervention options to be treated successfully; the outcomes of which we will monitor and present back to the hospital. This will relate to positive patient outcomes and quality of life, cost-savings in terms of tracheostomy removal and PEG avoidance, reduction in length of stay, and drop in number of pneumonias relating to aspiration. We will utilise current data relating to our caseload to compare intervention effectiveness, alongside cost-savings.

How is your project going to share learning?

As pioneers, adoption of this treatment will allow us to share our outcomes and innovative ways of practice across the UK. With the providers of the treatment, Phagenyx, recently achieving FDA approval for commercial sale in USA, we will have a global floor on which to present our expert status in the treatment. More importantly, our case studies will exemplify the Trust’s ability to think outside of the box and find solutions to patient rehabilitation.

Internally we will be able to share this with our peers across all sites in our Trust, ensuring equality of service is provided to all.  This will also be shared regionally with our HSCQI Q Community colleagues, as well as SLT networks.  We will happily share back all learning with Q Community beyond the minimum requirements for this funding, and offer on-site or virtual visits where feasible.