COLLABORATIVE DYSPHAGIA CARE BY SWALLOWING THERAPISTS AND NURSES: IMPACT ON ASPIRATION PNEUMONIA, NUTRITION, AND CLINICAL OUTCOMES; A SYSTEMATIC REVIEW

Abstract Background: Oropharyngeal dysphagia is common after stroke and critical illness and is strongly associated with aspiration pneumonia, malnutrition, dehydration, delayed medication delivery, and prolonged hospitalization. In real-world care pathways, nurses often perform early screening and daily feeding-safety tasks, while swallowing therapists provide formal assessment and targeted therapy. The clinical impact of structured collaboration between these groups across settings remains variably reported. Objectives: To synthesize evidence from original studies describing collaborative dysphagia care models involving nurses and swallowing therapists and their associations with aspiration pneumonia, nutrition, oral intake, and other clinical outcomes. Methods: A systematic review was conducted using PRISMA-aligned methods. We searched PubMed Central (PMC) for original studies describing dysphagia screening, management programs that explicitly integrated nursing actions with swallowing therapist assessment or therapy. Outcomes of interest included aspiration pneumonia, oral intake, nutrition measures, mortality, length of stay, and process outcomes. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I domains for non-randomized designs. Results: Ten original studies were included: one large registry analysis, multiple before–after, quality-improvement implementations, one randomized controlled trial, and additional observational studies. Across ICU and stroke pathways, nurse-led screening linked to therapist referral was associated with higher rates of oral feeding and lower pneumonia risk in adjusted analyses. Oral care protocols delivered by trained nurses as part of dysphagia management reduced aspiration pneumonia. Early swallowing therapy initiation after stroke improved recovery and reduced pneumonia. Evidence was limited by heterogeneity, frequent non-randomized designs, and incomplete reporting of nutrition endpoints. Conclusions: Collaborative nurse–therapist dysphagia care, particularly early screening, prompt therapist involvement, oral care, and early therapy, was consistently associated with improved pneumonia-related and oral intake outcomes, but stronger multicenter trials with standardized nutrition outcomes are needed.