Speech-Language Pathologist's Role in Tracheostomy Care

I completed a Bachelor and Masters of Music in voice performance at the University of Toronto. After graduating, I taught music for a few years and enjoyed working one-on-one with children and adults to help them develop their singing voice. When I was looking to switch careers, Speech-Language Pathology felt like a natural extension of teaching singing. Initially, I thought I would specialize in voice disorders or pediatrics given my background but I had a great clinical placement in acute care and decided that was where I wanted to work.  

I work on the Combined Surgical Unit and Medical Surgical and Neuro Intensive Care Unit (MSNICU) at Toronto Western. The population is a mix of post-surgical patients, general critical care patients and neuro patients including those with stroke, spinal cord injury, and neuromuscular diseases. I assess patients’ swallow function to determine their readiness to eat and drink as well as their ability to understand and communicate. Many of my patients have post-extubation dysphagia and dysphonia as well as new or chronic tracheostomies.

The trach team is a multidisciplinary team that rounds on all the trached patients in the hospital on a weekly basis. The purpose of the team is to promote appropriate management of tracheostomies thus ensuring optimal outcomes for these patients. In addition to documenting the findings of our assessment, we make recommendations regarding stoma care, weaning, cuff deflation, trach changes, and readiness for swallowing and communication assessment. We also provide education to family and staff. 

My primary role is to monitor patients’ readiness for swallowing and communication assessment so that they happen in a timely manner. Even before a swallowing assessment, I look at a patient’s ability to manage oral secretions during rounds and may give exercises so that they can start practicing their swallowing. When they’re ready for a swallowing assessment, I'll make sure a VFSS or FEES is completed. Many of our trach patients have voice or other communication impairments and so when they’re appropriate I’ll assess, make any necessary referrals (e.g., ENT, AAC clinic) and provide communication strategies or tools.

The trach team at Toronto Western is comprised of a respiratory therapist, a nurse specializing in wound and ostomy care, a Speech-Language Pathologist and several ICU physicians. We also consult with other professions including ENT and dietician. There are frequent opportunities to collaborate during and outside of rounds. For instance, SLP and RT can work together to determine whether a patient is ready for speaking valve trials. Wound care, RT and the physician might coordinate timing of suture removal. SLP and physician might discuss a patient’s appropriateness for long-term enteral feeding. Each member of the team brings a specific skillset and knowledge, and we learn from each other. 

Regular oversight means that issues are less likely to fall between the cracks. For instance, receiving regular follow-up with our team’s wound care nurse can reduce the risk of pressure injuries and other trach-related complications. With regards to quality of patient care, the literature shows that implementation of a multidisciplinary trach team is associated with improved decannulation rates and reduced length of hospital stay. In my experience, decisions regarding next steps are made and implemented more quickly when the team rounds together weekly rather than each of us seeing patients on our own and communicating about it after the fact. 

The Passy Muir website has some great free webinars. Attending in-services on trach management with SLP and RT colleagues has been really helpful. And of course, I ask my fellow trach team members a lot of questions during trach rounds. They’re often the best resource!

Thank you, Lauren, for sharing information about your role! 

Attached below are some resources regarding tracheostomy teams, including suggestions on how to establish one! 

Bonvento, B., Wallace, S., Lynch, J., Coe, B., & McGrath, B. A. (2017). Role of the multidisciplinary team in the care of the tracheostomy patient. Journal of Multidisciplinary Healthcare, 10, 391-398. https://doi.org/10.2147/jmdh.S118419 

de Mestral, C., Iqbal, S., Fong, N., LeBlanc, J., Fata, P., Razek, T., & Khwaja, K. (2011). Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. Canadian Journal of Surgery, 54(3), 167-172. https://doi.org/10.1503/cjs.043209 

Tobin, A. E., & Santamaria, J. D. (2008). An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: A prospective cohort study. Critical Care, 12(2), R48. https://doi.org/10.1186/cc6864 

Tracheostomy Education. (2022, February 5). How to form a tracheostomy team. https://tracheostomyeducation.com/how-to-form-a-tracheostomy-team/