Children with a tracheostomy: Global speech-language therapists' practice

Purpose: Speech-language Therapists (SLTs) are specialists in communication, feeding and swallowing as core members of the paediatric tracheostomy multidisciplinary team (MDT). Inconsistent tracheostomy care leads to staff and family frustration and delayed intervention. Little is known about international SLT tracheostomy practices. Methods: This global survey explored training, clinical practices, perceived knowledge, skills and roles, and barriers for SLTs working with paediatric tracheostomy. Survey questions consisted of Likert scale and openended questions. 92 SLTs completed the survey representing 6 continents and 19 countries. Results: Overall SLTs were confident in their knowledge of communication, and feeding but less confident in weaning, tracheostomy care skills (such as suctioning and cuff deflation) and specialist tracheostomy tube use (such as tracheostomy tubes with a subglottic suction port). Formal competency training was infrequent but most had access to supervision. Understanding of the SLT role by the MDT was perceived as good. Many felt managing one-way speaking valves was part of their role. The majority reported staffing, lack of guidelines and access to resources (one-way speaking valves and flexible endoscopic evaluation of swallowing) as barriers. Conclusions: This expert opinion paper summarises the current evidence-base and international paediatric tracheostomy practice. SLTs were experienced and confident in tracheostomy. The SLT role varies internationally with a lack of formal written policy to guide practice and a variability in access to education.