Implementation of a Referral Pathway and Peri-operative Checklist for Delivery of Surgical Tracheostomy Provision during the COVID-19 Pandemic.

Globally the SARS-CoV-2 pandemic has posed significant challenges in the delivery of clinical care, in part owing to the lack of an evidence base for treatment and formalised patient care pathways. Guidelines have been published on the technical protocol for surgical tracheostomy in SARS-CoV-2 patients [2], however it is important to also focus on the pre-operative referral process. In order to make assertions on whether tracheostomy may have aided weaning, it would be necessary to implement formal, standardised methods of patient selection and record variables that may allow eventual patient prognostication. With a view to address this issue we have established a COVID-19 tracheostomy referral pathway based on work by The British Laryngological Association (BLA) and multidisciplinary stakeholders at Barts Health NHS Trust (see online Appendix 1) [3].