Adult Tracheostomy Management: Insights from SLPs Around the World

A recent international survey by Miles and Wallace (2025) examined how speech-language pathologists (SLPs) manage adults with tracheostomies across a wide range of healthcare settings. Responses from SLPs in more than 50 countries highlighted both the essential role SLPs play in adult tracheostomy care and substantial variability in education, clinical responsibilities, and access to structured support. The authors note that one goal of the survey is to facilitate international collaboration among SLPs, with the aim of improving care and outcomes for people with tracheostomies worldwide.

Across settings, SLPs commonly reported involvement in communication and swallowing management for adults with tracheostomies. However, many clinicians described inconsistent referral timing, a lack of standardized protocols, and limited access to multidisciplinary tracheostomy teams. Many survey respondents emphasized the importance of tracheostomy teams that include SLP involvement to support timely and coordinated care. These findings align with previous research demonstrating that the presence of interprofessional tracheostomy teams is associated with earlier intervention, improved patient communication, reduced adverse events, and improved patient outcomes (Bettger et al., 2023; Pandian et al., 2022; McGrath et al., 2020).

Despite challenges related to limited access to tracheostomy teams and a lack of standardized protocols, respondents described numerous successful SLP-led tracheostomy initiatives associated with improved care processes and outcomes, including:

• Staff education and competency development related to tracheostomy care
• Development and participation in international tracheostomy working groups
• Nursing education and interdisciplinary training initiatives
• Enhanced respiratory therapy–SLP collaboration
• Relationship-building with ICU teams to support early intervention
• Increased use of FEES to support swallowing assessment and clinical decision-making
• Active involvement in patient and family education and training
• Standardized protocols supporting early SLP referral for communication and swallowing
• Development of policies supporting above-cuff vocalization and use of in-line speaking valves

Survey respondents frequently identified a need for additional training and education, particularly in settings where supervision and mentorship were difficult to access. Many emphasized the importance of structured learning opportunities to support consistent, evidence-based practice. These findings are consistent with earlier studies showing that many clinicians continue to face gaps in training, confidence, and access to ongoing education in adult tracheostomy care. (Khanum et al., 2022; Wiberg et al., 2022). Collectively, this evidence highlights the role of education and interdisciplinary collaboration in reducing practice variability and supporting safer, more timely intervention for adults with tracheostomies.

Clinical Takeaway

This growing body of evidence reinforces the importance of practical, accessible education and training to support SLPs involved in adult tracheostomy care. At Atos Medical, the Clinical Education team is actively working to address these needs through initiatives such as the Spot on Support (SOS) Program, live and on-demand webinars, and a new adult tracheostomy simulation developed in collaboration with Simucase, planned for release in early 2026. These resources are designed to support SLP student education, build clinician confidence, promote evidence-based decision-making, and strengthen interdisciplinary care across settings.

For more learning opportunities, reach out to our team through our Spot on Support program, visit our Event Hub for live and on-demand webinars, and check out the Simucase website for the new tracheostomy simulation.

Spot on Support (SOS):  Spot on Support (SOS)

Upcoming and On-demand webinars: Events

Simucase: Connie- Assessment (SLP)

References:

Bettger JA, Thomas L, Wallace S, et al. Effectiveness of interprofessional tracheostomy teams: a systematic review. Int J Nurs Stud. 2023;139:104405.

Khanum T, Zia S, Khan T, Kamal S, Khoso MN, Alvi J, Ali A. Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals. Braz J Otorhinolaryngol. 2022;88(2):251–256.

McGrath BA, Wallace S, Goswamy J. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2020;75(1):S86–S96.

Miles A, Wallace S. Management of adults with a tracheostomy: an international survey of speech-language pathologists’ practice. Int J Lang Commun Disord. 2025;60(2):e129–e144.

Pandian V, Miller CR, Mirski MA, et al. Multidisciplinary team approach in the management of tracheostomy patients. Otolaryngol Clin North Am. 2022;55(2):291–303.

Wiberg S, Whitling S, Bergström L. Tracheostomy management by speech-language pathologists in Sweden. Logoped Phoniatr Vocol. 2022;47(3):146–156.