title: A clinical audit of the management of patients with a tracheostomy in an Australian tertiary hospital intensive care unit: Focus on speech-language pathology.
abstract: Speech-language pathologists manage communication and swallowing disorders, both of which can occur in patients after tracheostomy insertion. An audit on the incidence and timing of speech-language pathology intervention for adults with tracheostomies has not previously been published. Data were retrospectively extracted from the medical records of all patients who were tracheostomized at Royal Prince Alfred Hospital, NSW, Australia, from October 2007 for 1 year. Extracted data included diagnosis, date and type of tracheostomy, time to speech-language pathologist involvement, time to phonation, and time to oral intake. Among the 140 patients (mean age 58 years, range 16-85), diagnoses were neurological (32%), head and neck (25%), cardiothoracic (24%), respiratory (6%), and other (13%). Speech-language pathology was involved with 78% of patients, with initial assessment on average 14 days after tracheostomy insertion (14 days to 166 days). Median time from tracheostomy insertion to phonation was 12 days (range 1-103). Median time from tracheostomy insertion to oral intake was 15 days (range 1-142). Only 20% of patients returned to verbal communication within 1 week after tracheostomy insertion. Further research into access to and timing of speech-language pathology intervention in the critical care setting is warranted.
authors.affiliation: Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia. amy.freeman-sanderson@sswahs.nsw.gov.au
authors.forename: Amy
authors.initials: A
authors.lastname: Freeman-Sanderson
authors.forename: Leanne
authors.initials: L
authors.lastname: Togher
authors.forename: Paul
authors.initials: P
authors.lastname: Phipps
authors.forename: Mark
authors.initials: M
authors.lastname: Elkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003147:Communication Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales; D010699:Phonation; D020127:Recovery of Function; D012189:Retrospective Studies; D013066:Speech-Language Pathology; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult