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"I jumped on board with IDDSI because I’ve always believed it would reduce errors in the food served to people."

John Holahan

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Choking Deaths by Patients with Dysphagia

Over the 5 years from 2013 – 2017, every 3 days a person with dysphagia has choked to death on their food.  Due to the privacy of death certificates and the lack of coroner inquiries in the US, we are unlikely to know for certain what lead to these deaths.  However, based on the reports from elsewhere in the world, we can guess that some of them come from miscommunication among care providers. 

A 2015 coroner’s investigation in Canada is a good example.  In this case, a 71-year-old woman died in the emergency department of a hospital where she had gone for examination after a fall.  Her diet order at the long-term care facility was “regular, puree, regular".  She was given a whole sandwich which is considered a “regular” texture diet.  She was found unresponsive with her mouth stuffed with food.  Suction efforts noted “+++ food” suctioned.  The patient had a Do Not Resuscitate order, so resuscitation efforts were discontinued.

It was only after the incident that the hospital learned that the terminology used by the long-term care facility - “regular, puree, regular” actually meant “regular diet, puree texture, regular fluids”. 

A simple communication error of the appropriate diet lead to this choking death. 

The International Dysphagia Diet Standardisation Initiative (IDDSI) is working to standardize dysphagia diet terminology across the globe.  One of the hopes is that errors like this case will be eliminated.  And we should see it in the data as time goes by.

I get asked on occasion what motivated me to jump on the IDDSI bandwagon so soon.  Many people think it was a straight business decision – IDDSI would push customers to us or we would sell more thickener.  But that really was not a big consideration.   

I jumped on board with IDDSI because I’ve always believed it would reduce errors in the food served to people.  I was digging around in a US government database and came up with statistic I opened this note with.  I know not all of these deaths are due to the wrong consistency or the wrong food being served or communication errors between people and/or facilities.  But I know some or many of them are.

Standardized terminology will lead to less of these errors and deaths in the future.  We can’t prove it (yet) but I know it will help. That’s why the work we are doing to implement IDDSI is so important. 

For the detail oriented, my data comes from looking at the CDC’s Multiple Cause of Death online analysis tool.  I just limited the data to the 5 most recent years. 

Death certificates in the US can list up to 20 causes of death, so I put in ICD 10 codes:

  • R13 (Dysphagia)

  • W79 (Inhalation and ingestion of food causing obstruction of respiratory tract)

  • I used the search operator ‘AND’ so it would show all cases with BOTH causes listed on the death certificate.

  • The result is 638 cases over 5 years = 127 per year, or about 1 every 3 days.



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