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Background Aims This study was undertaken to evaluate our tracheostomy service and identify reasons for any delays. Methods A retrospective study in an academic tertiary-care hospital in Jeddah, Saudi Arabia. Inclusion criteria were any patients in ICU who required a surgical tracheostomy over a 2-year period (January 2014 to December 2015). The primary outcome was delayed tracheostomy referral and secondary outcomes included the number of days between referral and consultation, days between consultation and tracheostomy placement, and mortality rates. Results Ninety-nine patients had a tracheostomy between January 2014 to December 2015 and could be analysed, mean age of 52.7 years, 44.5% females. The average duration from referral to tracheostomy was 5.12 days (SD 6.52). Eighteen patients (18.2%) had delayed tracheostomy (> 7 days from referral). The main reasons for the delay were the patient’s medical condition (50%, n = 9), followed by low haemoglobin (38.9%, n = 7). Administrative reasons were recorded in 5 cases only (28%); 2 due to operating room lack of time, 2 due to multidisciplinary issues, and 1 due to family refusal. Laboratory-confirmed low haemoglobin, a prescription of anti-platelets, or a prescription of anti-coagulation were not associated with a longer duration between referral and tracheostomy placement. An increase of 1 day in the time between referral and tracheostomy corresponded to an increase in delay in discharge from ICU of 1.24 days (95% CI 0.306 to 2.18). Conclusion Although most delays related to the clinical condition of the patient, administrative and multidisciplinary factors also play a role. Early tracheostomy (less than 14 days) from intubation increases the survival rates of patients and improves their clinical outcomes. Further prospective evaluation is needed to confirm the impact of delay in performing surgical tracheostomy among ICU patients whose bedside percutaneous tracheostomy is contraindicated.