Tracheostomy tube changes by speech-language pathologists: a service review of an expanded scope of practice

Abstract

Background/Aims Patients in acute care who have received a tracheotomy require efficient management to adequately progress through the acute care setting. This progression is predicated on efficient tracheostomy weaning through tracheostomy downsizing, capping and decannulation. The objective of this retrospective study was to review the outcomes of tracheostomy tube changes by speech-language pathologists. Methods A retrospective cohort analysis was performed of adult patients who received a tracheostomy tube change during their acute care hospitalisation by speech-language pathologists during a 6-month span in 2022. A total of 38 consecutive referrals undergoing an initial tracheostomy tube change had their electronic medical records reviewed. Success was defined as the placement of the tracheostomy tube into the tracheal lumen with confirmation of placement with no adverse events. Complications were recorded at the time of the tracheostomy tube change. Results Speech-language pathologists performed 38 (100%) initial tracheostomy tube changes successfully at the bedside without complications. The primary referral services were trauma and neurology. The primary diagnoses were polytrauma with a traumatic brain injury and multiple trauma without a traumatic brain injury or spinal cord injury. The mean Glasgow Coma Scale score and number of intubations were 12.4 and 1.4 respectively. A total of 34 (89%) tracheostomy tube changes resulted in the downsizing of the tracheostomy tube, while the remainder of tracheostomy tube changes (n=4; 11%) maintained the same size but were cuffless. All the tracheostomy tube changes were completed without complications, and all patients were noted as stable after 24 hours. Conclusions The procedural success corroborates the data reported by an earlier study in the literature and further validates the efficacy of a competent and experienced speech-language pathologists' ability to perform low-risk tracheostomy tube changes in the acute setting. This study demonstrates real world data from a single large trauma centre of tracheostomy tube changes performed by speech-language pathologists. Such data better defines the emerging role expansion of speech-language pathologists in the acute care setting. Implications for practice This study has the potential to expand the discussion around speech-language pathologists changing tracheostomy tubes in the acute care setting for a low-risk cohort. The authors have outlined the requisite training that may serve as a resource for speech-language pathologists to develop procedural competency.