Managing tracheostomy patients in general wards can be challenging, especially after discharge from intensive care. While a tracheostomy may support communication, weaning, and recovery, the transition to a less monitored environment can expose gaps in staffing, continuity, and specialist knowledge. This article highlights the main barriers ward nurses face and why structured tracheostomy support is essential for patient safety.
The management of adult patients with a tracheostomy is a significant challenge in healthcare, as approximately 10–20% of patients admitted to intensive care units undergo this procedure.1 A tracheotomy offers several advantages such as the possibility of communication and faster progression to weaning.2 The transition from the highly monitored intensive care environment to a general ward is considered a high-risk event because the medical complexity of the patient often persists while the level of monitoring and specialized nursing care is significantly reduced.3 Research indicates that patients discharged to wards with a tracheostomy may experience higher in-hospital mortality, due to a lack of skilled care required to manage specific emergencies outside the intensive care setting.4 In the highlighted study, the focus is on day-to-day obstacles that prevent safe recovery. For this purpose, the authors performed a secondary analysis of a qualitative dataset that was collected from interviews with Norwegian nursing staff.
The primary barriers to effective tracheostomy care
Four primary barriers to effective tracheostomy care have been identified:
- Ambivalence among staff
- Inadequate staffing levels
- A lack of patient continuity
- A lack of systematic follow-up
Nurses reported ambivalent feelings when patients were discharged from the intensive care unit without the possibility of readmission due to age or severity of illness. This situation often led to long-term patients receiving less specialized expertise and being assigned a lower priority of care. Inadequate staffing levels and a lack of specialized competency on general wards led to the nurses feeling insecure. Sometimes they even had to rely on the patient’s own guidance on care procedures. One of the nurses expressed her frustration with the following statement:
“Yes, you feel stupid because you do not provide the help you are supposed to. And sometimes the patient must tell you how to do things.”
This is further complicated by a lack of continuity: frequent staff rotations and the absence of permanent medical teams hinder the ability of nurses to truly know their patients’ specific needs. Finally, a lack of systematic follow-up was noted. The nurses struggle to receive assistance from the intensive care unit for tasks like suctioning or cleaning, especially during night shifts when resources are limited.
Why this matters for patient safety
Addressing these barriers is critical for ensuring patient safety and reducing healthcare costs. The ambivalence noted in the interviews raises difficult ethical questions regarding resource allocation5 and the risks associated with premature discharge, which can increase the likelihood of readmission and mortality.6,7 Many complications, such as mucous plugging, are avoidable with appropriate care and regular follow-up, yet knowledge gaps regarding tracheostomy emergencies remain a significant safety concern.8
It is recommended that hospitals implement dedicated tracheostomy teams and systematic follow-up programs to support ward staff and mitigate these issues. This type of structured support can help strengthen clinical confidence, improve continuity, and reduce avoidable complications on the ward.
Hospitals looking to strengthen competency can also turn to Atos Learning Institute’s e-learning and customized training programs for tracheostomy and laryngectomy.
PM42816_TcEN-202604