The Unseen Struggle: Evaluating Compliance With Dysphagia Assessment Guidelines in Hospitalised Parkinson’s Patients

BackgroundWhat is effortless for most -a simple act of swallowing -can pose a significant and often under-recognised risk for patients with Parkinson's disease (PD).Dysphagia is frequently overshadowed by the motor and nonmotor complexity of PD, yet it contributes substantially to aspiration pneumonia, malnutrition and disrupted medication delivery, particularly during acute hospitalisation.Aspiration pneumonia is recognised as the leading cause of mortality in Parkinson's disease, underscoring the clinical importance of early identification of swallowing impairment.The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommends swallow screening for all acutely unwell patients with Parkinson's disease and provides National Recommendations aimed at improving the quality and safety of dysphagia care during hospital admission.This audit aimed to evaluate local adherence to NCEPOD recommendations for dysphagia screening and management in hospitalised patients with Parkinson's disease. MethodsA retrospective quality-improvement audit was conducted at Scarborough General Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust.Forty-five acute admissions of patients with a confirmed diagnosis of Parkinson's disease between May 2023 and December 2024 were reviewed.Electronic patient records, prescribing records, Speech and Language Therapy documentation, nursing assessments and discharge summaries were assessed against NCEPOD recommendations.Audit measures included admission swallow screening, referral to Speech and Language Therapy and Parkinson's specialist services, timely administration of dopaminergic medication, nutritional screening, multidisciplinary involvement and documentation of swallowing-related information at discharge. ResultsSwallow screening at hospital admission was completed in only 18% (8/45) of cases.Among those screened, swallowing impairment was identified in 88% (7/8), a finding that, while based on a small screened subgroup, highlights the potential for clinically important dysphagia to remain unrecognised when systematic assessment is not routinely performed.During admission, 24% (11/45) developed new or worsening dysphagia; however, only 36% (4/11) were referred to Speech and Language Therapy.Timely dopaminergic medication administration was maintained in 91% (41/45) of admissions, although documentation of alternative medication routes in patients with dysphagia was inconsistent.Nutritional screening was completed in 51% (23/45) of cases, while swallowing-related advice was included in only 7% (3/45) of discharge summaries, highlighting gaps in multidisciplinary communication and continuity of care. ConclusionThis audit identifies meaningful gaps in the recognition and management of dysphagia among hospitalised patients with Parkinson's disease.Although swallowing impairment was common when assessed, inconsistent screening and variable escalation limited timely specialist involvement and continuity of care.Increasing awareness of bedside swallow assessments, such as sip tests, alongside a structured swallow checklist at admission, may improve early and consistent identification of swallowing impairment.Standardised multidisciplinary referral pathways and improved documentation, particularly at discharge, may further strengthen continuity of care, reduce aspiration-related risk and support safer, more coordinated management across acute and community settings.