Swallowing difficulties affect many hospital patients, but doctors and kitchen staff often used different terms to describe food textures, creating confusion and safety risks. Researchers at University Hospital Graz in Austria implemented a new global standard called IDDSI that gives everyone the same vocabulary for describing how soft or thick food and drinks should be. Over three years, they trained all staff—from doctors to chefs—on this system. The results showed that staff awareness of IDDSI jumped from 42% to 77%, and everyone started using the same language. This study proves that hospitals can successfully adopt this safety system, making swallowing care safer and more consistent for patients.

The Quick Take

  • What they studied: Can a large hospital successfully teach all its staff to use a single, standardized system for describing food textures and swallowing safety?
  • Who participated: University Hospital Graz, a large 1,554-bed hospital in Austria, involving doctors, speech therapists, nurses, dietitians, and kitchen staff across the entire facility from 2021 to 2024.
  • Key finding: Staff awareness of the IDDSI system increased from 42.1% to 76.7%, and staff consistently began using the standardized terminology throughout the hospital, proving the system could be successfully adopted.
  • What it means for you: If you or a loved one has swallowing difficulties in a hospital using IDDSI, you’ll likely receive safer, more consistent care because all staff members speak the same language about food safety. However, this study only shows one hospital’s experience, so results may vary elsewhere.

The Research Details

This was a real-world implementation study conducted at a major teaching hospital over three years. The research team, which included speech therapists, dietitians, and kitchen managers, created a detailed plan based on international guidelines for rolling out the IDDSI system. They started by examining every recipe in the hospital kitchen and every clinical assessment used by doctors to make sure everything matched IDDSI standards. The team then created training programs for all staff members—from nurses to cooks—to teach them the new system. They surveyed staff before and after implementation to measure how much awareness and understanding improved.

This approach is important because it shows how to successfully change practices across an entire large organization. Rather than just publishing guidelines, the researchers actually implemented them in a real hospital with hundreds of staff members and thousands of patients. This type of real-world evidence is valuable because it reveals practical challenges and solutions that wouldn’t show up in a laboratory study.

This study is a documented case of successful implementation at a major hospital, which adds credibility. The researchers used standardized assessment methods (staff surveys before and after) and involved multiple professional groups, which strengthens the findings. However, this is a single-hospital experience, so results might differ in other hospitals with different resources or staff. The study doesn’t compare outcomes to hospitals that didn’t implement IDDSI, so we can’t definitively say patient safety improved—only that staff awareness increased.

What the Results Show

The implementation was successful across all five targeted areas: clinical swallowing assessments, dietetic recommendations, recipe modifications, staff training, and electronic health record systems. Staff awareness of IDDSI nearly doubled, rising from 42.1% before implementation to 76.7% after. This means that by the end of the project, three-quarters of hospital staff understood what IDDSI was and how to use it. Additionally, staff began consistently using IDDSI terminology in their daily work, suggesting the system became embedded in hospital culture. The research team successfully modified all hospital recipes to match IDDSI texture levels, ensuring that food prepared in the kitchen met the standards that doctors prescribed for patients.

The study identified that having strong leadership from both a speech therapist and a dietitian was crucial to success. Kitchen staff engagement was particularly important—when chefs understood why texture modifications mattered for patient safety, they became champions of the system. The hospital’s existing food preparation system (Cook and Chill) required some adaptation to work with IDDSI standards, but this was achievable. The research showed that multiprofessional collaboration improved, meaning doctors, nurses, therapists, and kitchen staff communicated better about patient needs.

This is one of the first documented successful implementations of IDDSI in a large acute care hospital, making it a significant contribution to the field. Previous research had shown that IDDSI standards were needed to prevent confusion and improve safety, but few hospitals had actually implemented the system hospital-wide. This study provides a roadmap for other hospitals considering similar changes, showing that it’s feasible even in large, complex organizations.

The study only examined one hospital, so results may not apply to smaller hospitals, different countries, or hospitals with different resources or staff structures. The research didn’t measure whether patient outcomes actually improved—only that staff awareness and terminology use increased. We don’t know if the improvements lasted beyond the study period or how other hospitals might struggle with similar implementations. The study also didn’t compare this approach to other methods of implementing IDDSI, so we can’t say this is the best way to do it.

The Bottom Line

If you work in a hospital or healthcare setting, advocating for IDDSI implementation appears beneficial for improving communication and standardizing care for patients with swallowing difficulties. The evidence suggests this system is worth the effort to implement. For patients with swallowing difficulties, asking whether your hospital uses IDDSI standards may help ensure you receive consistent, safe care. Confidence level: Moderate—this is based on one hospital’s experience, but the results are promising.

Hospital administrators and healthcare leaders should care about this research because it shows how to successfully implement a safety system. Speech therapists, dietitians, and nurses working with patients who have swallowing difficulties should care because IDDSI improves their ability to communicate clearly. Patients with swallowing difficulties and their families should care because standardized systems may lead to safer care. This research is less relevant to people without swallowing difficulties or those in non-hospital settings.

Staff awareness increased significantly within the three-year implementation period, with most gains appearing to happen in the first year or two. However, maintaining this awareness and consistent use of terminology likely requires ongoing training and reinforcement. Patients may notice improved consistency in their meals and clearer communication about their dietary needs within weeks of the hospital fully implementing the system.

Want to Apply This Research?

  • If you have swallowing difficulties, track which IDDSI texture level you’re prescribed (Level 0-7 for foods, Level 0-4 for liquids) and note any meals that don’t match your prescription. This helps identify inconsistencies and provides useful feedback to your healthcare team.
  • Users can request that their healthcare provider document their prescribed IDDSI level in their medical records and ask kitchen staff to confirm they understand the prescription. Taking a photo of your meal and comparing it to IDDSI texture standards can help you verify consistency.
  • Weekly check-ins on whether meals match your prescribed texture level, noting any swallowing difficulties or choking incidents. Share this information with your speech therapist or doctor to ensure the prescription remains appropriate and is being followed consistently.

This research describes one hospital’s experience implementing IDDSI standards and does not constitute medical advice. If you have swallowing difficulties, consult with your doctor, speech therapist, or dietitian for personalized recommendations. The findings from this single hospital may not apply to all healthcare settings. Always follow your healthcare provider’s specific dietary and swallowing recommendations, regardless of whether your facility uses IDDSI standards.