Advancing post-operative care in Sweden

Veronica Lindberg, a Speech-Language Pathologist (SLP) with 23 years of experience, currently works at the University Hospital of Umeå in northern Sweden. With over 15 years dedicated to caring for people living with a laryngectomy, Veronica faces the challenge of managing patient care across vast distances in the northern region. Effective communication between hospitals and healthcare professionals is crucial to ensure patients feel safe and secure in their daily routines.

Collaborative efforts in the development of post-operative clinical care guidelines

Veronica and her colleagues have collaborated extensively over the past months, supported by Atos and the Atos Learning Institute. These meetings, both digital and in-person, have included representatives from Atos, SLPs from all Swedish university hospitals, nurses, and occasionally local hospital SLPs or doctors. They have reviewed Netherlands Cancer Institute's post-operative protocol and the evidence behind “best practice in laryngectomy care and rehabilitation”. They then compared it with current local practices, leading to constructive discussions and a consensus on the need for national guidelines.

The importance of national clinical guidelines

Veronica emphasizes the necessity of establishing national clinical guidelines for post-operative care following a total laryngectomy. These guidelines are important for several reasons:

• Evidence-Based Care: Ensuring that laryngectomized patients receive the best possible care based on the latest evidence.
• Team Coordination: Providing a clear framework for the team, from the university hospital to local hospitals, to follow the patient from day one post-surgery until discharge.
• Patient Education: Allowing patients ample time to learn and feel confident in their post-operative routines, which is essential for optimal pulmonary health, peristomal skin health, voice, and nutrition.

Key areas of focus in 'best practice' guidelines

The guidelines aim to address areas with the least consensus among Swedish hospitals and those that differ most from 'best practice'. Key focus areas include:

• Adhesive Use Post-Operatively: Encouraging minimal use of laryngectomy tubes unless strongly indicated⁽¹⁾.
• Day & Night HME Routine: Reducing pulmonary complaints through these practices⁽²⁾.
• Promote Early Oral Intake: as a safe practice⁽³⁾.
• Proactive Work with Patient Competencies: Supporting patient knowledge early in the recovery process.

Current stage of development

In October 2024, a draft for national clinical guidelines for post-operative care in Sweden was created during a meeting in Malmö. This proposal was presented at a Swedish Atos webinar in November, and the next step is to discuss how to implement the guidelines.

Challenges and solutions in implementation

Veronica identifies two major challenges in implementing these guidelines:

• Onboarding surgeons and doctors: Their consensus and agreement are crucial. Involving them in discussions and revisions is essential for success.
• Spreading awareness and adoption: Ensuring all professionals working with laryngectomized patients are informed and adhere to the guidelines. SLPs at university hospitals must take responsibility for implementation within their units and to inform and educate regional and local teams in continuum care.

By focusing on these areas, Veronica and her team aim to provide national post-operative clinical care guidelines to improve pulmonary health and overall quality of life.

Any recommendations in this educational material are a general guide for best practice, to be implemented by qualified healthcare professionals subject to clinical judgement and availability of healthcare resources.

The information presented should not be considered medical advice for specific conditions. A patient’s individual circumstances and preferences should always be considered and clinical practice should be in accordance with the principles of protection, participation and partnership.

References

¹ Griffith GR, Luce EA. Tracheal stomal stenosis after laryngectomy. Plast Reconstr Surg. 1982 Dec;70(6):694-8.

² Ward EC, Hancock K, Boxall J, Burns CL, Spurgin AL, Lehn B, Hoey J, Robinson R, Coleman A. Post-laryngectomy pulmonary and related symptom changes following adoption of an optimal day-and-night heat and moisture exchanger (HME) regimen. Head Neck. 2023 Apr;45(4):939-951.

³ Serbanescu-Kele CM, Halmos GB, Wedman J, van der Laan BF, Plaat BE. Early feeding after total laryngectomy results in shorter hospital stay without increased risk of complications: a retrospective case-control study. Clin Otolaryngol. 2015 Dec;40(6):587-92.

PM 36082_ThEN_202412