Guidance in Tracheostomy Care for Speech-Language Pathologists: The Green Light Tool

The purpose of this study was to investigate whether the implementation of the Green Light Tool for the evaluation and treatment of tracheostomy patients hospitalized at Maine Medical Center affects the time to initiating oral nutrition, use of speaking valves, and/or time to decannulation for temporary tracheostomies.

This pre-/post-intervention study uses retrospective chart review to collect data pre-intervention (e.g., Time 1) and at two time points post-intervention: 6 and 12 months after the Green Light Tool was implemented (e.g., Times 2 and 3, respectively).

Data from 200 participants were included (Time 1: n = 100, Time 2: n = 50, Time 3: n = 50). Participants from each time period were similar along sex, age, and diagnosis. Participants in Time 1 had a statistically significant shorter length of stay compared to participants in Time 2 (adjusted [adj] p = .005) and Time 3 (adj p = .010). Following implementation of the Green Light Tool, speech-language pathologists (SLPs) received assessment consults sooner after a temporary tracheostomy was placed (adj p < .001), and patients with tracheostomies were evaluated by SLPs earlier in their hospitalization (adj p = .006). There was no significant difference on patient-centered outcomes, such as time to speaking valve use, capping trials, decannulation, oral trials, diet initiation, modified barium swallow, or placement of a percutaneous endoscopic gastrostomy tube.

Use of the Green Light Tool improved the timeliness and consistency with which SLPs evaluated patients and the self-reported comfort SLPs felt when assessing patients with tracheostomies. Possible reasons for a lack of effect on patient-centered outcomes, including the interference of COVID-19, are discussed.