key: cord-0880387-7fenjomw authors: Moser, Chandler H.; Freeman-Sanderson, Amy; Keeven, Emily; Higley, Kylie A.; Ward, Erin; Brenner, Michael J.; Pandian, Vinciya title: Tracheostomy care and communication during COVID-19: Global interprofessional perspectives date: 2021-12-23 journal: Am J Otolaryngol DOI: 10.1016/j.amjoto.2021.103354 sha: 4c5432debe4f5e340283eac54b0e0c2e70b020bd doc_id: 880387 cord_uid: 7fenjomw OBJECTIVE: Investigate healthcare providers, caregivers, and patient perspectives on tracheostomy care barriers during COVID-19. STUDY DESIGN: Cross-sectional anonymous survey SETTING: Global Tracheostomy Collaborative Learning Community METHODS: A 17-item questionnaire was electronically distributed, assessing demographic and occupational data; challenges in ten domains of tracheostomy care; and perceptions regarding knowledge and preparedness for navigating the COVID-19 pandemic. RESULTS: Respondents (n = 115) were from 20 countries, consisting of patients/caregivers (10.4%) and healthcare professionals (87.0%), including primarily otolaryngologists (20.9%), nurses (24.3%), speech-language pathologists (18.3%), respiratory therapists (11.3%), and other physicians (12.2%). The most common tracheostomy care problem was inability to communicate (33.9%), followed by mucus plugging and wound care. Need for information on how to manage cuffs and initiate speech trials was rated highly by most respondents, along with other technical and knowledge areas. Access to care and disposable supplies were also prominent concerns, reflecting competition between community needs for routine tracheostomy supplies and shortages in intensive care units. Integrated teamwork was reported in 40 to 67% of respondents, depending on geography. Forty percent of respondents reported concern regarding personal protective equipment (PPE), and 70% emphasized proper PPE use. CONCLUSION: While safety concerns, centering on personal protective equipment and pandemic resources are prominent concerns in COVID-19 tracheostomy care, patient-centered concerns must also be prioritized. Communication and speech, adequate supplies, and care standards are critical considerations in tracheostomy. Stakeholders in tracheostomy care can partner to identify creative solutions for delays in restoring communication, supply disruptions, and reduced access to tracheostomy care in both inpatient and community settings. As the COVID-19 pandemic has unfolded, the controversial questions of tracheostomy timing, techniques, and early outcomes [1] [2] [3] [4] [5] [6] have sometimes eclipsed the softer voices of patients, caregivers, and front-line workers. Yet, these perspectives are critical, as they can surface underappreciated or neglected needs across the continuum of care [7] [8] [9] [10] and survivorship [11] . The number of critically ill patients requiring mechanical ventilation and tracheostomy continues to climb, and the corresponding needs for routine tracheostomy care and related help identify the most pressing areas for future training and clinical support to optimize tracheostomy care. A cross-sectional descriptive study was conducted using an anonymous online survey. A convenience sample of participants of a Global Tracheostomy Collaborative (GTC) educational webinar on pandemic tracheostomy care was invited to participate. Participants included a global audience of otolaryngologists, critical care physicians, nurses, speech-language pathologists, respiratory therapists, individuals with tracheostomy, family members, and caregivers registered prior to an educational virtual symposium series. No participants were individually recruited for this study. Participants were included based on their live attendance at the webinar (live or recorded version), with no exclusion criteria specified. The survey was announced live by the webinar organizers during the online event. The survey was designed to assess perceptions regarding tracheostomy care during the COVID-19 pandemic, emphasizing barriers to care and associated concerns (Supplemental One-hundred-fifteen participants completed the survey. The overall response rate was 22% Demographic information is summarized in Table 1 . Responses to tracheostomy-related challenges included limited availability of personal protective equipment (40.0%), difficulty accessing community-based care (38.2%), and procuring disposable equipment (31.3%). Respondents also noted concern regarding access to medical center care and durable equipment (Figure 1) . Responses were relatively consistent across geographical regions, with PPE availability being the most consistently reported problem (Figure 2) . Respondents from Australia and the United Kingdom were most likely to perceive the teamwork at their local or associated facility as having maximally integrated teamwork (66.7% and 60.0%, respectively). Only 51% of respondents from the United States responded similarly (Figure 3) , with lower rates among other countries. J o u r n a l P r e -p r o o f Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study Early vs. late tracheostomy in ventilated COVID-19 patients -A retrospective study Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes The value of tracheostomy of critically ill COVID-19 patients -A multicentral study Life after Tracheostomy: Patient and Family Perspectives on 10 The Primacy of Patient-Centered Outcomes in Tracheostomy Care Transitions of Care After Critical Illness-Challenges to Recovery and Adaptive Problem Solving Acquired laryngeal and subglottic stenosis following COVID-19-Preparing for the coming deluge Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. The Lancet Respiratory Medicine Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression, anxiety, and stress levels Critical care health professionals' self-reported needs for wellbeing during the COVID-19 pandemic: A thematic analysis of survey responses Early recovery following new onset anosmia during the COVID-19 pandemic -an observational cohort study COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic Facilitating speech in the patient with a tracheostomy Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum Communicating Effectively With Hospitalized Patients and Families During the COVID-19 Pandemic Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care Compassionate Communication Amid the COVID-19 Communicating with conscious and mechanically ventilated critically ill patients: a systematic review Optimizing Communication in Mechanically Ventilated Patients Interventions to enable communication for adult patients requiring an J o u r n a l P r e -p r o o f Journal Pre-proof artificial airway with or without mechanical ventilator support A critical care pandemic staffing framework in Australia Teamwork in a pandemic: insights from management research Balancing cognitive diversity and mutual understanding in