Come Together: Utilizing Early Speech Therapy Consults to Decrease Aspiration Pneumonia in Geriatric Trauma ICU Admissions

General Information

Institution Name: HCA Doctors Hospital of Augusta 

Author Name and Title: Shelby Adams RN, MSN, TCRN, CEN 

Name of Case Study: Come Together: Utilizing Early Speech Therapy Consults to Decrease Aspiration Pneumonia in Geriatric Trauma ICU Admissions 

Identification of Local Problem

Doctors Hospital of Augusta (DHOA) is a Level II ACS verified adult trauma center. In 2024, DHOA saw a total trauma volume of 2,373 patients, with 26% (616) being geriatric trauma admissions. This vulnerable population is at a higher risk of developing complications during hospitalization, such as aspiration pneumonia. DHOA identified 13% of geriatric patients admitted to the ICU in 2024 who experienced an unplanned event related to aspiration pneumonia. Implementing early speech-language pathology consultation, ideally within 24 hours of ICU admission, is supported by evidence demonstrating a reduction in aspiration pneumonia.

Context of the QI Activity

The objective is to develop and implement a standardized process aimed at reducing aspiration pneumonia among geriatric trauma patients admitted to the ICU. The initiative focuses on early collaboration between ICU leadership and Speech Therapy by ensuring a speech therapy evaluation is completed within 24 hours of admission. The project targets geriatric trauma patients in the ICU and seeks to improve consistency in consults, screenings, and evaluation timeliness. Data review revealed key opportunities for improvement, including limited routine screenings and delays in completing speech therapy evaluations.  

What were the interventions?

Initial data findings were reviewed by the Trauma Performance Improvement (PI) Coordinator, focusing on unplanned events in geriatric trauma patients related to aspiration pneumonia. Data was presented to trauma surgeons supporting evidence-based research on ordering speech therapy consults upon ICU admission for geriatric trauma patients. The study period consisted of March 2025–September 2025, with a patient population focusing on geriatric trauma patients admitted to the ICU. Exclusions include patients with a GCS 13 or less, or patients admitted and remaining on the ventilator during length of stay, requiring a PEG tube. The process consisted of the admitting trauma physician placing a speech consult with initial admission orders. Speech therapy would then receive the order and complete the screen within 24 hours. Education was provided to ICU nurses and leadership, emphasizing collaboration with speech therapy to prevent aspiration pneumonia through early intervention. PI Coordinators participated in daily huddles and multi-disciplinary rounds to encourage open communication with speech therapists, trauma physicians, and ICU staff—ensuring consults were completed for each patient. Data was tracked for all geriatric trauma ICU admissions to monitor compliance and outcome.

Cost and Funding Sources

Cost and funding of sources were absent. There were no extra costs associated with this QI project. Staffing grids and productivity were also not impacted by the QI project.

Overall Results and Analysis

This quality improvement project successfully reduced aspiration pneumonia among geriatric trauma ICU patients, resulting in fewer adverse events. Between March 23, 2025- September 9, 2025, data showed a 97% reduction in unplanned events related to aspiration pneumonia and 100% compliance with speech therapy evaluations completed within 24 hours of order placement. Collaboration between ICU leadership and Speech Therapy was vital to success, ensuring timely evaluations and consistent follow-up. The process proved sustainable and easily reproducible across departments, emphasizing the value of interdisciplinary teamwork and early intervention in improving patient outcomes.

Limitations

Analysis of data was a small sample size of patients, limiting the validity of the project proposal. This could be augmented by expanding the QI projects to all geriatric trauma admissions. The short time frame to validate the QI project is also limited. Further implementation will provide a better determination of the validity of the project.

Lessons Learned

During the QI initiative, a need for further accountability with the ordering process was identified. During the weekends, morning rounds and multi-disciplinary rounds did not occur, resulting in potential opportunities to miss consult orders. Accountability and communication during weekend shifts were heightened by the trauma surgeon team to ensure orders were placed.