title: UK survey of clinical consistency in tracheostomy management.
abstract: BACKGROUND
  Many speech and language therapists (SLTs) work with patients who have a tracheostomy. There is limited information about their working practices and the extent to which recent publications and research have influenced the speech and language therapy management of the tracheostomized patient.
  
  
  OBJECTIVE
  This study reviews the current patterns of clinical practice for SLTs in the management of adult tracheostomized patients in the UK.
  
  
  METHODS
  An online questionnaire was completed by 106 SLTs with prior experience in tracheostomy management. The information from this was explored to determine patterns of practice across various areas of speech and language therapy tracheostomy management including clinical roles and responsibilities, management of communication disorders, and assessment and management of dysphagia and decannulation. These clinical patterns were then examined with respect to the current literature, emerging patterns in evidence-based practice and national practice guidelines.
  
  
  RESULTS
  The results indicate a moderate to high level of clinical consistency in the majority of areas evaluated across the scope of tracheostomy management in speech and language therapy. Consistency in practice areas such as increased utilization of instrumental assessments and conservative use of the Modified Evans Blue Dye Test indicate clinical application in line with current research. Limited clinical consensus or inconsistencies in evidence-based services were identified in aspects of practice that are supported by conflicting or emerging research evidence. Such areas include involvement in cuff deflation regimes, adoption of specific decannulation procedures and participation in multidisciplinary team management.
  
  
  CONCLUSIONS
  SLTs in the UK provide a moderate to high level of consistent practice in tracheostomy management. This study identifies areas of tracheostomy management that require further research in order to establish clinical practice guidelines and to address discrepancies between research evidence and clinical implementation.
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McGowan
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.forename: Laurelie R
authors.initials: LR
authors.lastname: Wall
authors.forename: Leanne R
authors.initials: LR
authors.lastname: Shellshear
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Spurgin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003147:Communication Disorders / Q000534:rehabilitation*; D003680:Deglutition Disorders / Q000534:rehabilitation*; D020878:Device Removal / Q000534:rehabilitation; D055317:Evidence-Based Practice; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D013066:Speech-Language Pathology / Q000379:methods*; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000534:rehabilitation*; D006113:United Kingdom; D055815:Young Adult
keywords: adults; speech and language therapy; survey; tracheostomy