289 - Tracheostomy Care Isn’t What It Used to Be: Insights from an SLP and a Surgeon

How confident are you in your trach and vent knowledge?  What about the interprofessional collaboration, patient advocacy, and therapeutic techniques we should be fighting for with this population? In this episode of the Swallow Your Pride Podcast, Rachael Silveira, a passionate tracheostomy specialist, teamed up with Dr. Nicole M. Yordán López, a surgical critical care fellow, to address the gaps in tracheostomy care they witnessed. They noticed that patients were falling through the cracks and not receiving the optimal care they deserved. And let me tell you, their journey to revolutionize tracheostomy care is nothing short of awe-inspiring.

One of the more striking points of our discussion is the cultural shift they've witnessed in tracheostomy care. Nicole, who started five years ago, admitted to having limited knowledge about tracheostomy care initially. But through collaboration and continuous learning, she has become a fierce advocate for optimizing patient outcomes. It's incredible how education and collaboration can shape our practice and bring about positive changes.

They have created a culture of learning and sharing knowledge at their hospital, educating residents and fellows about the crucial role of speech-language pathologists (SLPs) in tracheostomy care. By providing opportunities for observation during procedures like flexible endoscopic evaluation of swallowing (FEES), they are equipping future generations of medical professionals with the necessary skills and knowledge.

Another aspect that caught my attention was the emphasis on patient care and setting them up for success beyond the hospital. Rachael and Nicole prioritize rehab and work with ventilator settings to facilitate rapid weaning off the ventilator. They understand the challenges of coordinating procedures and tests before discharge, but they advocate for the patient's needs and ensure necessary interventions are in place for a seamless transition to another facility.

Collaboration and communication are at the heart of their practice. They encourage SLPs and healthcare professionals to reach out for help and use each other as resources. Delays in care can have a significant negative impact on a patient's quality of life, so timely interventions and assessments are crucial. They stress the importance of early consultations and communication with the surgical team, as well as educating patients and their families.

References:

Davis, Stephanie et al. “Speech Pathology Services Are Integral, but Underutilized in Tracheostomy Rehabilitation.” Craniomaxillofacial trauma & reconstruction vol. 14,2 (2021): 110-118. doi:10.1177/1943387520948381

Warnecke, Tobias et al. “Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients.” Critical care medicine vol. 41,7 (2013): 1728-32. doi:10.1097/CCM.0b013e31828a4626

Links:

274 – Curating a Multidisciplinary Tracheostomy Dream Team – Part 1 – Rachael Silveira M.A., CCC-SLP

275 – Curating a Multidisciplinary Tracheostomy Dream Team – Part 2 – Rachael Silveira M.A., CCC-SLP

Timestamps:

[00:02:48] Collaboration and Advocacy for Tracheostomy Care

[00:06:41] Roles of Surgeons and Speech-Language Pathologists in Tracheostomy Care

[00:09:15] Culture Shift in Tracheostomy Care

[00:10:17] Gaining Knowledge in Tracheostomy Care

[00:11:50] Collaboration and Education in Tracheostomy Management

[00:18:02] Inline pacing and ventilator settings 

[00:19:26] Collaboration between SLPs and physicians 

[00:22:39] Setting patients up for success in the next level of care

[00:26:17]Collaboration and Communication in Tracheostomy Care

[00:27:25]The Impact of Providing a Voice to Patients

[00:28:02] The Ideal Course and Setup for Tracheostomy Care

[00:34:26] Evaluating Secretions and Managing Tracheostomy 

[00:35:09] Tube Exchange and Downsize Considerations

[00:39:00] Collaboration and Communication in Tracheostomy Care

[00:43:49] Importance of interdisciplinary collaboration in tracheostomy care and patient outcomes.

[00:44:01] Challenges in tracheostomy management and the need for better communication and education.

[00:45:11] Advocacy for the use of fees (Fiberoptic Endoscopic Evaluation of Swallowing) in tracheostomy patients and its impact on patient care.

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