Although the term ‘tracheostomy’ simply means a hole entering the trachea, it can be usefully divided into tracheostomy (in which a hole is made between the anterior neck and the trachea, which remains otherwise intact) and laryngectomy (in which the larynx is removed and the trachea is joined to the neck as a blind-ending stoma). Both groups of patients have an increased risk of complications outside and within hospitals. Many of these are entirely avoidable by better knowledge and reliability of care. There is confusion about different types of tracheostomy and between management of complications of tracheostomy and laryngectomy stoma. There is a need for clear understanding of the differences and what represents good care of such patients and their airways. Complications include airway blockage and displacement. Harm may occur if airway emergencies are not managed promptly and in a structured manner. Standard operating procedures, algorithms and checklists have a role in improving reliability of care and approaches to emergencies. Recent evidence shows multidisciplinary teams using quality improvement principles can reduce complications, hasten decannulation and improve patient experience. The National Tracheostomy Safety Project and the Global Tracheostomy Collaborative have been established to improve education and safety of tracheostomy care.