Ward environment
In the hospital studied, ‘ward nutrition assistants’ who are trained to support patients at mealtimes, are available on stroke and care of the elderly wards. Results suggest that the presence of a ward nutrition assistant was not a significant factor for allocation of treatment group. However, presence of specialist support staff may contribute to frequency of dysphagia therapy offered – an outcome not measured in this study. The National Clinical Guidelines for Stroke23 highlight that patients should receive a minimum of 45 minutes of each therapy required at least five days a week. Availability of specialist staff to assist SLTs can support management of dysphagia in the acute hospital setting 24 and when direct SLT input is limited, oral trials may provide an opportunity for dysphagia therapy to be delivered by a range of staff within the multi-disciplinary team and across the 24-hour picture of a patient’s care.