Tracheostomy decannulation process model: an interprofessional, Latin-American Delphi consensus

Abstract

Objective: Tracheostomy decannulation is a critical step in patient recovery, yet practices remain heterogeneous worldwide. We aimed to develop a comprehensive, consensus-based model of the tracheostomy decannulation process tailored to Latin American healthcare systems. Design: Three-round Delphi consensus using the Process-Oriented Delphi Method. Setting: Multinational, multicenter study across Chile, Argentina, Mexico, and Ecuador. Participants: Seventy-five healthcare professionals with expertise in tracheostomy care, including physicians, nurses, speech therapists, respiratory therapists, and physiotherapists. Fifty-five experts completed all rounds. Interventions: An initial process model was constructed from a structured review of the literature and institutional protocols. Through iterative Delphi rounds, experts reviewed, refined, and reached consensus on activities, decision nodes, and professional responsibilities within the decannulation pathway. Activities were modeled using Business Process Model and Notation. Main variables of interest: Consensus on inclusion of activities (>80% agreement threshold), professional role assignment, and decision criteria for decannulation readiness. Predefined stopping rules were applied when response stability was achieved. Results: The final consensus model comprised 15 main activities organized into seven subprocesses. Each activity was assigned to specific professional roles, with conditional decision nodes integrated to account for clinical variability. No consensus was reached on precise physiological thresholds (e.g., cough peak flow). Procedures such as bronchoscopy were incorporated conditionally depending on patient context. Conclusions: An interprofessional Latin American panel successfully developed a standardized tracheostomy decannulation process. This consensus-based model provides a clear, adaptable framework to guide clinical practice, improve role clarity, and inform future research.