Give patients what they want: impact of tracheostomy quality improvement program on patients’ psychological wellbeing

Tracheostomy placement is often a life-saving airway procedure, and to most patients, it is a new and unpleasant experience which can lead to anxiety and distress.1 Psychological distress may be compounded by a lack of communication, inconsistent or fragmented care, or care from poorly trained or prepared staff.2 Improving Tracheostomy Care (ITC), a 20-site UK quality improvement (QI) program, was set up to implement Global Tracheostomy Collaborative’s resources into the UK NHS.3 We aimed to investigate the ITC’s impact on patients’ psychological wellbeing. Following ethical approval, diverse NHS Trusts were guided through three-phases of the QI program: baseline (0 months), implementation (12) and evaluation (24). Specific program elements addressed communication, vocalisation and staff training, hypothesized to reduce anxiety. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate patients’ psychological experiences. HADS consists of 14 questions, each scored 0-3, with seven questions each focussing separately on anxiety and depression. Total scores ≤ 7 are considered ‘no case’ (for depression/anxiety) in each category; scores of 8-10 inclusive ‘borderline’; and scores ≥ 11 are ‘cases’. The internal consistency (reliability) of HADS was evaluated by Cronbach’s alpha. Summary scores and categorical cases were examined using Microsoft Excel and IBM SPSS 22.0, with group comparisons made using Fisher’s exact test. Eleven sites contributed HADS questionnaires (142 at Baseline, 128 at implementation and 144 at evaluation phases). At baseline, 54.2% of patients were classified as anxious (35.9%) or borderline anxious (18.3%), with a significant drop to 37.4% by the end of the program (20.0% anxious, 17.4% borderline, p