A Physiotherapists take on Tracheostomy Care

Wednesday, July 30, 2025

Physiotherapist and Tracheostomy service lead Paul Twose shares his experience working within the NHS and providing care for patients who have had a Tracheostomy. 

Within your role, how does your clinical experience inform the work you are doing?

As a physiotherapist who has worked in critical care for 16 years, and had roles within head & neck surgery, I have a lot of experience the provision of care for adults that require a tracheostomy. Over the years, I have learned how our health systems can amplify challenges faced by these individuals.

Around 7 years ago I began trying to make improvements. Initially focusing on what could be done locally and then developing to try to support other health systems.

Using my clinical experience and vital links with the multi-professional teams (this is most important!), we were able to focus on delivering quality improvement programmes and the creation of an in-patient tracheostomy service. The learnings from this work combined with further collaboration has led to additional projects aimed at enhancing education. These projects use virtual reality and resources for the community and ambulance service to launch a TRACHEShub which supports adults and children with a tracheostomy, and an innovation project.

How common are tracheostomies, and what do you see as the major challenges to providing optimum patient care?

In the UK, 15000 – 17000 adults and 1500 children per year require a tracheostomy. The vast majority of these are inserted for people requiring prolonged mechanical ventilation, with other reasons including airway obstruction, burns, trauma and as part of a surgical procedure.

Literature suggests that around 1 in every 4 people will experience some form of adverse event because of the tracheostomy or it’s aftercare. These events range from minor harm caused by pressure damage or local infection, up to significant hypoxic events and even death.

Whilst it is common to have patients with a tracheostomy in intensive care, the support for those in ward and community environments is far more variable. As a result, ensuring staff have the necessary knowledge and skills to properly care for tracheostomy patients is vital. This can be hugely challenging when considering the range of clinical areas, the potential number of staff and the heterogeneity of those requiring a tracheostomy.

What are the insights that you as a physiotherapist can bring to patient care, and how does that tie in with the work of other members of the multidisciplinary team?

Physiotherapists, and indeed all Allied Health Professionals (AHPs), provide holistic care working across the entire patient pathway. In the case of those requiring a tracheostomy, this can be from insertion during intensive care, through acute care and out into community settings. AHPs work collaboratively, utilising each other’s unique skills and shared ethos to provide interventions based on patient needs.

Physiotherapists have a traditional background in the provision of respiratory care and as such have expert knowledge of ventilation, secretion management and cough augmentation. These skills are key in supporting those requiring tracheostomies. Through understanding the underlying physiology and utilising a range of assessment tools, physiotherapists can support the tracheostomy weaning process and, where necessary, provide interventions to aid the process.

Multi-professional working is a vital part of patient care. Input from speech and language therapists throughout the process allows a sharing of skill sets and understanding of both upper airway and respiratory function. Early utilisation of communication aids, such as speaking valves or above cuff vocalisation, enhances weaning potential, supports the wellbeing and aids quality of life for the person with the tracheostomy.

Additional multi-professional support from colleagues in intensive care, ENT and respiratory also allows for rapid troubleshooting, and provision of long-term support where necessary.

What support is out there for clinicians wanting to improve their practise? Are there any developments people should keep any eye out for?

Over the past 10 years, much focus has been placed on providing support for healthcare professionals caring for people with tracheostomies. This has been driven by the National Tracheostomy Safety Project (NTSP) and complemented by a wide range of clinicians both in the UK and internationally.

Resources are available, including educational material provided by the NTSP, e-learning via e-learning for health, and across NHS Wales access to the TRACHES bundle delivered in conjunction between the Institute of Clinical Science and Technology and Cardiff and Vale UHB.

2025 will also see the the release of the first iteration of ‘Principles of care for adults living in the community with a tracheostomy’. This is a collaborative project between 14 NHS organisations, focusing on providing the key principles for supporting adults that have a tracheostomy and require discharge from hospital to live in community settings. This document and supporting appendices will be available across health and social care.