Clinical consistency in tracheostomy management

Abstract

The study aim was to determine the current management patterns of clinicians across various settings in Australia and examine these practices with respect to levels of clinical consistency and evidence-based practice. A questionnaire was sent to 90 speech pathologists with experience in tracheostomy management. Sixty-eight clinicians responded, and their data were analyzed in relation to majority patterns and level of clinical consistency as per Mathers-Schmidt and Kurlinski (2003). Overall, the results suggested a moderate to high level of clinical consensus for the majority of issues examined. In most cases clinical practice was consistent with existing expert opinion, scientific research evidence, or national practice guidelines. There were, however, some aspects of clinical care that had little clinical consensus. Lack of consensus appeared to stem from either conflicting expert clinical opinion or absent/emerging scientific support. Some aspects of clinical care, including working in teams and the use of instrumental procedures in dysphagia assessment, were found to be inconsistent with best practice, based on current available research evidence. The current data highlight the need for more research evidence in order to establish true evidence-based practice guidelines and optimize clinical consistency of speech pathology management for the tracheostomized patient.