Short Swallowing Screen for Inpatients above 65 years
Care Process & Redesign
National Healthcare Innovation and Productivity Medals
National University Health System
30 January 2026
To reduce the risk of choking by implementing a Nurse-led Speech Therapist referral initiative in older adult patients using. The initiative successfully reduced choking incidents and improved compliance and diet appropriateness, suggesting that nurses play a.
Year Submitted: 2025
Published Date: 30 January 2026
Tags: Care Process ＆ Redesign, Productivity, Cost Saving, Quality Improvement, Workflow Redesign, Value Based Care, Safe Care, Preventive Approach, Risk Management
About this Content
Aims
To reduce the risk of choking by implementing a Nurse-led Speech Therapist referral initiative in older adult patients using a short swallowing screen tool.
Background
High incidence and prevalence of dysphagia among the elderly, associated with choking and aspiration pneumonia. Failure to screen for dysphagia can result in inappropriate diets prescribed, increasing incidence of choking accidents.
Methods
A short swallowing screen (3S) with 3 questions was adapted from the 4-point questionnaire test (4QT) to be carried out by nurses. The initiative was piloted in phases across different wards.
Results
Reduction of choking incidences from 6 incidents (2013-2019) to 1 incident (2020-2023). Achieved 80% compliance rate of nurses using the screen, and majority of patients are receiving the appropriate diet (90%).
Following the success in Phase 3, the 3S has spread to surgical-ortho, oncology, and cardiac clusters in September 2023, with sustained compliance rates.
Conclusion
The initiative successfully reduced choking incidents and improved compliance and diet appropriateness, suggesting that nurses play a critical role in dysphagia screening.
Lessons Learnt
Nurses can effectively screen for dysphagia, enabling appropriate diet/fluids to be ordered and assisting in streamlining appropriate patients to be referred to speech therapists for intervention.
Keywords
dysphagia, choking, screening, diet, intervention
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | National University Hospital |
Platform(s) | National Healthcare Innovation and Productivity Medals |
Healthcare Professional Group(s) | Allied Health, Medical, Nursing |
Applicable Specialty or Discipline | Allied Health, Speech Therapy, Medical, Geriatric Medicine, Nursing, Nursing Research |
Project Lead(s) | Naw Hnin Yee Aye, Guo Yiting Emily |
Project Member(s) | Chloe Ang Hui Min |
Connect with this contributor!
Naw Hnin Yee Aye - aye_hy_naw@nuhs.edu.sg
Guo Yiting Emily - emily_yt_guo@nuhs.edu.sg
Project Attachment
437_NUH_NHIP_2024_Short_Swallowing_Screen_for_Inpatientsabove_65_years.pdf