Interprofessional Quality Improvement Project to Reduce the Length of Stay of Tracheostomized Patients in a Multi-Etiological Intensive Care Unit - The Contribution of Speech and Language Therapy to the Overall Result (IQ-ICU-SLT)

Sep 30, 2026

Upload by jayni

Background/Objectives: Extended intensive care unit (ICU) stays arise from multiple critical factors, including prolonged ventilator weaning with post-extubation dysphagia (PED) and the presence of a tracheal cannula. In an interprofessional quality management project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy collaborate to reduce length of stay (LOS). SLT targets tracheal cannula management (TCM) and PED to enable fast, safe decannulation. Methods: Two SOPs for PED management and structured TCM were implemented in a postoperative ICU with increased SLT staffing, compared against a historical control. Results: Clinically relevant improvements were observed for decannulation timing and LOS. Conclusions: Integrating SLT into ICU care is feasible and reduces time to decannulation and overall LOS.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article Interprofessional Quality Improvement Project to Reduce the Length of Stay of Tracheostomized Patients in a Multi-Etiological Intensive Care Unit—The Contribution of Speech and Language Therapy to the Overall Result (IQ-ICU-SLT) Jürgen Konradi 1, *, Isabella Neef 2, Lukas Müller 1, Robert Kuchen 3, Heike Maagh 1, Ulrich Betz 1 and Marc Bodenstein 2 Academic Editor: Béla Fülesdi Received: 31 October 2025 Revised: 12 December 2025 Accepted: 22 December 2025 Published: 31 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; [lukaswerner.mueller@unimedizin-mainz.de](lukaswerner.mueller@unimedizin-mainz.de) (L.M.); [heike.maagh@unimedizin-mainz.de](heike.maagh@unimedizin-mainz.de) (H.M.); [ulrich.betz@unimedizin-mainz.de](ulrich.betz@unimedizin-mainz.de) (U.B.) 2 Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; ineef@students.uni-mainz.de (I.N.); marc.bodenstein@unimedizin-mainz.de (M.B.) 3 Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; [robert.kuchen@uni-mainz.de](robert.kuchen@uni-mainz.de) * Correspondence: juergen.konradi@unimedizin-mainz.de; Tel.: +49-6131-17-2362 Abstract Background/Objectives: Reasons for long-term stays in intensive care units (ICUs) include various critical conditions, prolonged weaning with post-extubation dysphagia (PED), as well as the mere presence of a tracheal cannula. In an interprofessional QM project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy work together to reduce the length of stay (LOS) in ICUs. SLT focuses on tracheal cannula management (TCM) and PED. The primary aim of SLT is fast and safe decannulation and thereby the reduction in LOS. Methods: Two SOPs for dealing with PED patients and for structured TCM were developed for this purpose and were both implemented in a postoperative ICU, together with a SLT staff increase. To compare the effects on the intervention group (IG, n = 54), a historical control (HC, n = 58) group was created through a retrospective data analysis. We screened all patients from ICU (n = 5605), including those with tracheostomy, and analyzed them during their ICU stay. Results: Clinically relevant results were observed for the mean time in days of tracheostomy in those who could bedecannulated (HC = 43.43, IG = 23.8; d = 0.99) and, even more importantly, for LOS in days (HC = 33.41, IG = 23.8; d = 0.48) . Conclusions: The integration of SLT in ICU care is feasible and helps to reduce the time to decannulation and LOS. Keywords: tracheostomy; decannulation; ICU; LOS; SLT; quality management 1. Introduction Patients who remain in intensive care units (ICUs) for extended periods face a high disease burden and increased risks of illness and death. Factors contributing to extended ICU stays include multiple organ failure, unstable circulation, delirium, prolonged ventilator weaning with post-extubation dysphagia (PED), and the presence of a tracheal cannula (TC), which can complicate transfers to other wards or care facilities due to their limited capacity to manage such cases [1] . Tracheostomized ICU patients experience an even greater burden, with longer hospital and ICU stays, higher mortality rates, and a greater chance of being discharged to a care facility. These patients often have severe underlying conditions, and tracheostomy may prompt a reassessment of patient goals and advanced care planning [2] . Strong respiratory function, demonstrated by powerful cough reflexes and e

FAQs

What causes prolonged ICU stays for tracheostomized patients in this project’s rationale?

The background highlights multiple factors, including prolonged weaning with post-extubation dysphagia (PED) and the presence of a tracheal cannula, which can complicate care transfers. Tracheostomy is also associated with longer hospital and ICU stays and higher mortality risks.

What specific role does speech and language therapy (SLT) play?

SLT focuses on tracheal cannula management (TCM) and management of post-extubation dysphagia (PED). Its primary aim is fast and safe decannulation to reduce ICU length of stay (LOS).

How was the intervention implemented and evaluated?

Two SOPs were developed for PED patients and for structured TCM, then implemented in a postoperative ICU alongside increased SLT staffing. Outcomes for an intervention group were compared with a historical control created via retrospective data analysis of ICU patients.

Sep 30, 2026

Upload by jayni