Purpose This exploratory study investigated the experiences, perceptions, and needs of hospital-based speech-language pathologists (SLPs) in South Korea regarding the assessment and intervention of patients with tracheostomy. The findings aim to provide foundational data for developing standardized guidelines and strengthening SLPs’ professional competencies. Methods A questionnaire was developed consisting of four domains: participant information (11 items), education and clinical experience (36 items), perceptions of assessment and intervention (35 items), and confidence in assessment and treatment (2 items). Data were collected online via Google Forms (n = 57). Descriptive statistics and independent t-tests were performed using SPSS version 20, with the significance level set at p < .05. Results SLPs with higher academic degrees and certification levels demonstrated significantly greater awareness of tracheostomy-related issues. However, only 10.6% reported receiving prior training, and 54.4% had clinical intervention experience, mostly limited to adult patients. While the necessity of speech-language intervention was widely recognized, confidence in assessment (M = 2.74) and treatment (M = 2.84) was low. Nevertheless, participants expressed strong recognition of the need for further education and research, as well as a high willingness to participate in training opportunities. Conclusions The findings highlight gaps in clinical experience and confidence among Korean hospital-based SLPs, underscoring the urgent need for structured education programs, standardized guidelines, and multidisciplinary collaboration systems to improve the quality of care for tracheostomy patients.