Wide variation in the way tracheostomy care is delivered in the United States has led to efforts to standardize care to reduce complications. These efforts are happening both at the local level, among an increasing number of institutions developing and implementing their own standardized approach to tracheostomy care, and on the national level, as demonstrated by the recently published clinical consensus statement by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (Otolaryngol Head Neck Surg. 2013;148:620).
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February 2013Published in September 2012, the clinical consensus statement provides a list of statements on tracheostomy care. A multidisciplinary panel of experts achieved consensus on these statements by using the modified Delphi method, which offers a way to refine expert opinion and facilitate consensus. The panel included representatives from pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy and emergency medicine.
According to the lead author of the study, Ron Mitchell, MD, the William Beckner MD Distinguished Chair in Otolaryngology at UT Southwestern Medical Center, Children’s Medical Center Dallas in Dallas, the consensus statement should be viewed as a road map for the care of a patient with a tracheostomy starting from the time the patient is prepared for the procedure and lasting through the education of patients and caregivers on tracheostomy care after discharge.
He emphasized that the areas of concensus achieved by the panel on tracheostomy care are based on opinion and practice and not on high quality published evidence, qualities that distinguish a consensus statement from a clinical guideline. “A guideline is a document that is based on the best available evidence,” he said. “A consensus document recognizes that there is not enough evidence to come up with a guideline and is basically an opinion-based document of a group of experts in the field.”