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Feasibility Study Demonstrates Free Water Protocol May Improve Fluid Intake, Swallow-Related Function and Quality of Life for Dysphagia Patients in Long-Term Acute Care Hospital Settings

WALLINGFORD, CONNECTICUT, February 23, 2023 — Patients with dysphagia in long-term acute care hospital settings may benefit from a Free Water Protocol, according to a new feasibility study by Gaylord Specialty Healthcare’s Milne Institute for Healthcare Innovation that was published today in the journal Scientific Reports.

Dysphagia – or the difficulty or inability to safely swallow – is a common diagnosis among adult patients in long-term acute care hospitals. Dysphagia can be caused by a number of factors, including neurological damage and disorders, intubation, radiation, and damage to the esophagus. According to the American Speech-Language-Hearing Association, dysphagia can lead to many serious consequences if not addressed, including aspiration pneumonia.

“Patients with dysphagia are often prescribed thickened liquids to help control their swallow function or are given no liquids at all,” explained Gaylord Specialty Healthcare speech-language pathologist Stefanie Gaidos, MS, CCC-SLP, co-author and lead investigator of the study.

“While this intervention may minimize the risk of aspirating liquids,” she said, “people do not generally enjoy consuming thickened liquids and often look forward to drinking a regular glass of cold water.”


The study trialed a Free Water Protocol among patients with dysphagia at Gaylord Hospital, a long-term acute care hospital in Connecticut.


The goal of the feasibility study was to determine if individuals in the long-term acute care setting who knowingly aspirate thin liquids and maintain regular oral hygiene (teeth brushing and Chlorhexidine rinse at least three times a day) can safely tolerate un-thickened water. A stringent oral hygiene routine is a vital component of the protocol as poor oral hygiene and dysphagia are among the most significant risk factors for developing aspiration pneumonia.

Once participants began the Free Water Protocol, measurements were taken over a seven-day trial period, and participants were monitored for adverse events until the protocol was discontinued.

The study resulted in no adverse events related to the Free Water Protocol and demonstrated significant changes including improved fluid intake, functional eating ability, and quality of life. One participant said, “If it wasn’t for the water, I would never have gotten better this quickly.”


The authors noted that the Free Water Protocol may benefit individuals undergoing rehabilitation for COVID-19 related post-intubation dysphagia and other dysphagia-causing diagnoses not represented in the study.

The results of the feasibility study resulted in the hospital-wide implementation of the Free Water Protocol at Gaylord Hospital.

About Gaylord Specialty Healthcare:
Gaylord Specialty Healthcare is a rehabilitation-focused, nonprofit health system headquartered in Wallingford, Connecticut, that provides inpatient and outpatient care for people at every point in their journey from illness or injury to maximum recovery.


Gaylord Specialty Healthcare is anchored by Gaylord Hospital, a long-term acute care hospital, and includes Gaylord Outpatient Services and Gaylord Physical Therapy for patients who require diagnosis and treatment on an outpatient


basis. Gaylord's Milne Institute for Healthcare Innovation is a hub for accelerating rehabilitative research, technology development and innovation to improve the quality of life and function of people around the world. Together, these entities deliver a complete continuum of rehabilitative care driven by clinical experience, innovation, and human compassion.