The whiteboard at the bedside is the default communication tool for most tracheostomy and laryngectomy patients. It's familiar, cheap, and requires no training. It is also slow, silent, and frequently illegible — and for patients who will be voiceless for weeks or longer, the cost of those limitations adds up.

A dedicated AAC app on a phone or tablet does the same job an order of magnitude better. Here's when to make the switch, why it matters, and how to set it up at the bedside without disrupting clinical workflow. We use Aacoris for tracheostomy as the example because it's free, works offline, and stores data locally — all relevant in clinical settings.

Why whiteboards fall short

Whiteboards work for the first few hours. Past that, the limits become visible:

• Speed. Writing a sentence takes 20–60 seconds. A nurse waiting at the bedside is a nurse not seeing other patients. The patient feels the pressure and writes shorter, less complete messages.
• Legibility. Trach patients are often weak, sedated, or have IV lines in their dominant hand. Handwriting gets worse as fatigue builds — exactly when communication matters most.
• Silence. Whiteboards don't speak. Staff and family have to read every message before responding. The conversation moves at reading pace, which is much slower than speaking pace.
• No memory. A wiped whiteboard is gone. Frequently-needed phrases are written from scratch every time.
• Dexterity. Holding a marker while attached to monitoring equipment is awkward. Tapping a button is easier.

A tap-to-speak AAC app removes every one of these limits. The tradeoff is the device cost and the 10-minute setup, both of which are trivial in context.

When to make the switch

Three trigger points are worth watching:

1. The patient is going to be voiceless for more than 48 hours. At 48 hours, the friction of the whiteboard starts costing the patient real things — pain control, family contact, sleep.
2. The patient is alert and motivated to communicate. Some sedated or delirious patients aren't yet candidates. Most are, faster than the team realizes.
3. A device is available. A family-owned phone or tablet is usually the easiest. A unit-owned tablet works if your facility allows it.

If those three are true, the whiteboard is the wrong tool starting today.

A 10-minute bedside setup

This is the install pattern that works in most ICUs and step-down units.

Step 1 (1 minute) — Install Aacoris

Download from the Play Store onto the patient's device or a unit-approved tablet. No account is required. The full app is free.

Step 2 (2 minutes) — Walk through the four built-in categories

Show the patient the Medical, Daily Needs, Family, and Emergency tabs. Tap a few phrases so they hear the voice. The voice surprises everyone the first time; it's worth getting that out of the way before the patient has to use it for real.

Step 3 (4 minutes) — Pin the top eight phrases

Most trach patients use roughly the same eight phrases more than anything else:

1. "I need suctioning."
2. "I'm in pain."
3. "I need water."
4. "I need to use the bathroom."
5. "I'm hot."
6. "I'm cold."
7. "Get the nurse."
8. "Call my family."

Pin those to Favorites. They should be one tap from the home screen.

Step 4 (3 minutes) — Add the patient's specifics

Open the Medical category and add:

• The patient's specific medications and dose times
• Allergies
• Surgery date and type
• The names of the family members the patient most wants to call

This is the difference between a generic communication board and theirs. Five minutes of bedside personalization makes the app actually get used.

Training the people around the patient

The patient will use the app whether or not the people around them know about it. The point of training is to make sure those interactions land well.

For nursing staff

A 60-second handoff at change of shift:

"This patient uses Aacoris on the tablet at the bedside. Their Favorites are the eight phrases pinned at the top. The emergency phrases are in the red category. The shake-to-activate alarm calls for help if they can't tap."

A printed one-pager at the bedside helps. So does a sticker on the chart.

For family members

Family training is shorter than people expect:

• Hand the device to the patient. Don't tap on their behalf.
• Wait for the response. Don't fill the silence.
• Read the screen, listen for the voice, and respond at speaking pace.

Most family members get this in five minutes. The hardest part is breaking the habit of guessing.

Common pitfalls

A few things that derail trach AAC setups and how to avoid them:

• The device gets put on a table the patient can't reach. Mount it, prop it, or use a flexible arm. The single most common reason an AAC app stops getting used is physical reach.
• The screen is too dim. ICU rooms are often kept dim for sleep. Adjust the device brightness and font size for the patient's vision.
• The Favorites get stale. Two minutes a week, by the SLP or a family member, is enough to keep them current.
• Nobody trains the night shift. AAC use drops at night because the new staff weren't briefed. A laminated one-pager at the bedside fixes this.

At discharge

The biggest single advantage of an AAC app over a whiteboard is that it goes home with the patient. Discharge is where most communication setups break — the home doesn't have a whiteboard, doesn't have IV-drip-trained nurses, and doesn't have the same patience.

Because the patient already uses Aacoris in the hospital, discharge doesn't introduce a new tool. The same eight phrases, the same medications, the same family names — same app. The continuity reduces re-admission risk associated with frustration, missed medications, and family burnout.

A note on laryngectomy patients

Laryngectomy patients usually graduate from AAC eventually — to esophageal speech, an electrolarynx, or a tracheoesophageal prosthesis. Until then, and for situations where their alaryngeal voice is hard to understand (phone calls, drive-thrus, noisy stores), an AAC app is the right backup. Many patients keep Aacoris installed for years as a fallback even after they've returned to speaking voice.

About the Author

Aacoris Team — Building accessible AAC tools for tracheostomy, laryngectomy, and other voiceless patients in clinical and home settings.

Related guides

• AAC for Tracheostomy & Laryngectomy — full pillar
• Emergency Communication Tips
• Offline AAC Strategies
• AAC for Speech-Language Pathologists

Resources

• Learn more about Aacoris
• Download the Aacoris App