AHA indicates American Heart Association; ASA, American Stroke Association; ED, emergency department; ICH, intracerebral hemorrhage; and TJC, The Joint Commission. Appendix. Continued 5. Dysphagia Screening Within 24 h: Percentage of patients 18 y of age with a diagnosis of ICH for whom there is documentation that a dysphagia screening was performed within 24 h of admission using a dysphagia screening tool approved by the institution in which the patient is receiving care Numerator Patients for whom there is documentation that a dysphagia screening was performed within 24 h of admission using a dysphagia screening tool approved by the institution in which the patient is receiving care* Denominator Included patients: All patients 18 y of age with a diagnosis of ICH Excluded patients: <18 y of age Length of stay >120 d Enrolled in a clinical trial related to stroke that would affect dysphagia screening Discharged before 24 h Documented reason that dysphagia screening was not indicated. Reasons could include coma, intubation, or that the patient was entirely dependent on enteral feeding (without oral intake of food, liquids, or medications) before hospitalization as a result of a chronic medical condition. Period of Assessment Within 24 h of hospital admission Sources of Data Prospective flowsheet, retrospective medical record review, electronic medical record Rationale Dysphagia is present in up to 67% of patients with acute stroke, and of these, almost 50% have aspiration, a prerequisite for aspiration pneumonia. Up to one third of patients who aspirate develop pneumonia. Pneumonia is a serious complication of stroke and is associated with increased mortality. Several studies have demonstrated a reduction in pneumonia after institutional implementation of dysphagia screening protocols but without randomized control groups. 