By the patient, for the patient. Determining key quality of care measures for improving tracheostomy care.

Abstract

Around 20,000 new tracheostomies are inserted annually in the UK. Quality of care may be measured by structure, process, outcome and patient experience. Our pilot work demonstrated the robust utility of quantitative quality indicators in measuring process (referral times, times to vocalisation and first oral intake) and outcome (patient safety incidents, lengths of stay). Our objectives were to further investigate qualitative and quantitative data that could describe the
tracheostomised patient experience. Defining their baseline psychological wellbeing and the baseline satisfaction level with their care allows us to evaluate the impact of improvement programs.

Following ethical approval and adoption onto the National Institute of Healthcare Research Portfolio, UK NHS Trusts were selected to participate, recruiting adult and paediatric patients with experience of tracheostomy. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Hospital Anxiety and Depression Scale (HADS) tools collected data, with a thematic analysis conducted to analyse free text entries.

A total of 142 and 120 patients from 10 hospitals completed HADS and HCAHPS questionnaires respectively. Qualitative analysis identified themes focussed on oral intake and vocalisation. Tracheostomy patients demonstrated high levels of psychological distress: 98 (69.0%) were classified as having at least borderline anxiety or depression, with 36 (25.4%) meeting criteria for both anxiety and depression. There was a significant difference between HCAHPS ‘top box’ scores assigned to the tracheostomy-relevant questions between sites (p=0.01) indicating varying satisfaction with care.

Our baseline data demonstrates that whilst psychological distress is prevalent, tracheostomy patients generally report positive experiences about their care, although the highest satisfaction scores are achieved in less than half of all categories. These metrics can track the impact of improvement efforts such as through the Global Tracheostomy Collaborative (www.globaltrach.org). Improvement efforts should focus on (and measure) times to oral intake, vocalisation and duration of care, all identified as important to our patients.