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Project SITUP: An Interdisciplinary Quality Improvement Initiative to Reduce Aspiration Pneumonia

O'Malley, Mary, Beth, MSN, RN, ACNS-BC; Trotta, Rebecca, L., PhD, RN; Rohrbach, Jeffrey, MSN; Ahya, Vivek, MD, MBA; Bradway, Christine, PhD, RN, GNP-BC

doi: 10.1097/NCQ.0000000000000285

The purpose of this quality improvement initiative was to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on 3 inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased.

Hospital of the University of Pennsylvania, Philadelphia (Ms O'Malley and Drs Trotta and Bradway); Department of Biobehavioral Sciences, University of Pennsylvania School of Nursing, Philadelphia (Drs Trotta and Bradway); University of Pennsylvania Health System, Philadelphia (Mr Rohrbach); and Pulmonary, Allergy & Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dr Ahya).

Correspondence: Christine Bradway, PhD, RN, GNP-BC, University of Pennsylvania School of Nursing, 418 Curie Blvd/Claire M. Fagin Hall, Room 312, Philadelphia, PA 19104 (

With thanks to the nurses and all other colleagues who participated in this initiative and in particular: Neil Fishman, MD; Randy Dubin, MA, CCC-SLP; Betty Ann Boczar, MS, RN, NEA-BC.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Accepted for publication: July 7, 2017

Published ahead of print: August 24, 2017

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