Abstract

Introduction: Patient satisfaction is one of the core objectives of health care facilities and an indicator of how well the patient is being treated. It refers to the quality of care while a growing factor in the effectiveness of hospital services. More and more hospitals are starting to pay attention to patient experience. Aim: to identify the aspects of satisfaction of patients and their families in both adult and pediatric governmental Emergency Departments and their recommendations of improvement. Methods: Cross section survey using (Brief Emergency department Patient Satisfaction Scale (BEPSS). The sample size was 300 patients, 150 from adult emergency at Mansoura hospital and 150 from pediatric emergency at Bannha hospital as a convenience sample. Result: The waiting time in the adult ED ranged from (5 minutes to 120 minutes) and most admissions were at the morning shift. While at the pediatric hospital the waiting time ranged from 5 minutes to 100 minutes) and most of admissions were at the afternoon shift. The results showed that the main domain in BEPSS in adults was respecting patient’s family while in pediatric it was the nurse’s care about treatment. The main recommendation of improvement in pediatric ED was modifying the procedures while in adult ED was training the physicians. Conclusion: Training physician is the main domain recommended by patient and their families of improvement in adult ED while modifying procedures and skills for both nurses and physician is the main domain in pediatric ED.

1. Introduction

In the emergency department (ED), patients satisfaction is a main role of the ED staff nurses because, they are the first contact in hospital care. The picture is overall determined by relationship between doctors or nurses and patients yet the contribution of nursing staff plays a major part ¹.

The triage is the first place to sort the patient according to criticality and patients deal with hospital staff. Prompt service is essential for patients, possibly the primary factor determining their judgment. Positive or negative opinion of nursing triage can have an impression on patient satisfaction and determine whether or not he will return to a specific ED ².

Generally, Patient satisfaction is used as an indicator at the emergency department for measuring the quality of service care delivered. It depends on the satisfaction of patients’ demands and expectations ³.

Measures of patient satisfaction with emergency care have been developed and tested for use in adult populations yet the comparison between adult and pediatric EDs was not fully investigated ^{4, 5}. With regard to the pediatric context, the AAP (American Academy of pediatrics) defines Patient-centered and family-centered care PFCC as “an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and providers that recognizes the importance of the family in the patient’s life ⁶.

Waiting times at Emergency department (ED) have a serious impact on patient outcome, as clinical indicators of mortality, morbidity with readmission in less than 30 days, length of stay, and customer satisfaction. Previous studies bears out the logical evidence that since the outcome of treatment for all diseases and injuries is time-sensitive. The sooner treatment is rendered, the better the outcome. ⁷.

The Institute of Medicine recommend that patient-centered care is geared toward “Delivering care that is respectful of and responsive to individual patient favorites, needs, and values, and ensuring that patient values guide all clinical decisions. Patient- and family-centered care raises that “health care that is empathetic, includes patients and families as partners and collaborators, is provided with respect, and treats patients and families with dignity ⁸.

Parents have more ability than children's to participate in care and private discussions with emergency staff. While children and parents provided similar assessments, children gave lower scores than the predicting factors for children's and their parents' satisfaction with emergency department care ⁹.

Patient centered and Family centered care is the core approach of quality of the healthcare so evaluation of patient and family satisfaction is an essential work might be difficult to achieve in the setting of emergency. The current work studied the opinion of patients and families in different emergencies in both adult and pediatric emergency departments.

The aim of study was to identify the aspects of satisfaction of patients and their families in both: the adult and the pediatric Governmental Emergency Departments and their recommendations of improvements.

2. Methods

A combined descriptive and cross-section design was used to define the phenomenon, situational problem, and attitude of patients at different settings in the same time. To emphasized the main problems and perception of admitting patient regarding ED.

Two Governmental Hospitals are participated at research study in different Governorates

1) Mansoura Hospital: is seven floors adult emergency hospital - Total number of beds is 180. At Dakahlia Governorate

2) Bannha Pediatric Hospital is a two floor pediatric emergency hospital. Total number of beds is 136. At Qalyubia Governorate

Both hospitals for non- profit investment, and have inpatient, outpatient and operation room services for all cases admission.

The sample was non-random; convenience sampling methods from adult and pediatric patients, 150 patients was enrolled from each ED. For total sample size 300 patients selected according to including criteria for adult and pediatric patients: both sex, the age range from 1 to 10 years for pediatric and adult from 18 to 60 years old who were co-operative and agreed to participate in the study research, during the period (from 1st of Jan 2019 to 1^st of March 2019), but not including patients following motor vehicle collision, or those with severe mental disorder, congenital anomalies, antisocial, and crime issues.

Brief emergency department patient satisfaction scale (BEPSS), self-administration scale was utilized ¹⁰ and was translated to Arabic version questionnaire and validated by three juries consultants at Misr University for Science and Technology. The BEPSS is a five level Liker scale has seven parts: Part 1: Personal characteristics. Part 2: Level of satisfaction about Emergency services (4 items). Part 3: Environment satisfaction at emergency room (8 items): Part 4: Measure the satisfaction about staff (11 items). Part 5: Measure the privacy at emergency room (2 items). Part 6: Measure the satisfaction of timing in the emergency room (1 item). Part 7: Satisfaction about the return back for the same emergency room. Researchers added Part 8: Asked the patient about their perception for improvement of emergency room (8 items)

Ÿ Formal approval was done according to hospital policy and ethics committee.

Ÿ The questionnaires were distributed to nurses at both settings of ED, covered by front sheet explaining the aim of study and how to complete the questionnaire with patient even if they illiterate. (Tips and guidance of nurses)

Ÿ Explaining the aim of the study was to the patients and / or their partners who were admitted to ED in Mansoura hospital and / or Banha teaching hospital by ED staff. Verbal approval was obtained from the participants and Subject’s participation as fully voluntary in three shifts.

Ÿ The estimated time to complete the questionnaire ranged from 10-15 minutes.

Ÿ The staff selected the participants according to inclusion criteria which help the staff to fulfill the study goal achievement.

Data were analyzed using the IBM Statistical Package of social science program (SPSS) version 23. Descriptive and Inferential statistics were used to find the mean score and percentages of patient satisfaction. Researchers used independent t-test and ANOVA test.

Ethics committee approval was taken from hospitals, Informed consent from Authorized person and from data collection settings were obtained. Subjects’ participation was fully voluntary. The confidentiality of the obtained data was completely secured by providing code numbers for each subject.

3. Results

Three hundred patients were evaluated (150 adults and 150 pediatrics). The majority of admissions in the adult hospital ED were males (71%) and 46 % of the patients were accompanied by their fathers and 81% entered the ED for admission to the hospital (Table 1). The waiting time ranged from 5 to 120 minutes mostly in the morning shift. Most of the adult patients were illiterate.

On the other hand the pediatric hospital showed equal gender distribution and most of the cases entered the ED for admission to the hospital. The waiting time ranged from 5 to 100 minutes in the afternoon shift. The majority accompanying the children were non parents and most of them held diploma certificate.

Table 1: It presented that the majority of the admission in acute adult hospitals are males. Fifty percent of them are coming with their father's and most of them enter ED for admission. The average duration of waiting time range is from (10 - 20 min) in morning shift. Most of them don't hold certificates (Illiterate people). On the other hand at the pediatric hospitals boys and girls are at the same percentage and most of them enter the ED for admission to. The average duration of waiting time range is from (10 - 20 min) in the afternoon shift.

Table 1: It presented that the majority of the admission in acute adult hospitals are males. Fifty percent of them are coming with their father's and most of them enter ED for admission. The average duration of waiting time range is from (10 - 20 min) in morning shift. Most of them don't hold certificates (Illiterate people). On the other hand at the pediatric hospitals boys and girls are at the same percentage and most of them enter the ED for admission to. The average duration of waiting time range is from (10 - 20 min) in the afternoon shift.

Table 2: shown the aspects of ED. satisfaction in the adult hospital as ranked in order in different domains of BEPSS it showed the following: respecting the patient's family (3.7) was the first concern followed by, hygienic environment (3.6), and calm a quiet environment (3.5). The rank in the pediatric hospital differed: nurse's care about treatment came in the first rank (3.18), followed by suitable staff who inform about remaining treatment (3.10) and the physician inform about treatment course in a respectful way (2.9) same as the ED well-functioning.

Table 3 showed that the training of physicians (41%) and modifying procedures skills (26%) were the highest recommendations for the improvement of the ED for the adult patients while reducing the waiting time recommended by pediatric patient and their partners.

4. Discussion

Quality indicators of care focus on the patient's satisfaction to measure the delivery service in emergency departments. Definitely emergency care makes an important role to reduce avoidable deaths and disabilities in development countries. The percentage of patients' dissatisfaction causal needs investigation in order to improve inadequacies ¹¹. The ED is a special department among other medical care services, thus, understanding the factors affecting patient satisfaction is essential and carries different aspects compared to other healthcare facilities.

Level of education might or might not have affected the degree of satisfaction. Patients with a lower educational level (illiterate, primary, and secondary levels) could be less satisfied. Patients well educated were seeking for listening and integrating of medical debate. Accordingly, they might understand the outcome of the critically ill patients ¹².

The issue of overcrowding and waiting times in EDs is a chronic and worsening problem. It receives considerable coverage in the media which report that the waiting times are one of the prime processes for the health care system should assessed. The present studies showed that the average duration of waiting time was 20 minutes at both hospitals (Adult and Pediatric). These results are compared to meta-analysis results of previous systematic review study the emergency waiting time was (21-78) and managed by the emergency nurse practitioners service to be (11.5-76) ¹³. So the current studies reported that the waiting time of the practical nurses at the emergency rooms within the average range to the others.

In the existing study most of the ED patients who attended in the pediatric hospitals in the afternoon shift might have affected the overall satisfaction. The results reported that the average satisfaction of the ED staff was (2.59) this average was less than the other studies estimating the overall satisfaction ^{14, 15, 16}. This could be explained by different hospital settings and different cultures of measuring.

The present studies, have shown that the highest satisfaction score by patients is as the following: The patient's family are respected in this hospital in the adult ED; the environment being hygienic in the pediatric ED; and infection prevention remains a major challenge in emergency care. Unfortunately sever ill and injured patients are seeking for an evaluation and treatment in the emergency department (ED) but they don't only have the potential to spread communicable infectious diseases to healthcare personal and other patients, Also the vulnerable group are liable to acquiring new infections associated with the care they received. Being satisfied with the department hygienic care is an evidence of potential for proper infection control in emergency situations.

Results showed a discrepancy in satisfaction between the adult ED and the pediatric ED patients. This discrepancy can be explained by the dissimilar presence with patients in both groups besides Pediatric ED patients differ markedly from adult ED patients in regards to anatomical and physiological characteristics, then also in various factors such as the reason for visits, injury or disease severity, and the presence of chronic disease ¹⁷. For example, the proportion of pediatric patients who need intensive care or admission due to severe injury is relatively low compared to that of adult patients. Considering these characteristics, the ideal facility criteria, pediatric ED equipment, and human resources have been investigated in some countries ¹⁸.

5. Recommendation

The chief recommendation from patient perception was; improve EDs performance by improving the doctors training this concordant to several previous literature reviews who have identified various factors contributing to ED patient experience and their recommendations to improve performance. Previous studied reviewed 50 articles meeting selection criteria and found that the strongest predictor of ED patient satisfaction was the quality patient–ED provider interpersonal interaction and recommended increase training of healthcare providers ¹⁹.

In the same year, research study identified a collection of service factors (e.g., interpersonal skills, perceived staff attitudes, provision of information/explanation, aspects related to waiting times) with influence on patient experience and healthcare provider training was on top of patient’s recommendation also ²⁰.

Second recommendation should be modifying the skills of administrating procedure of healthcare givers by continuous education and appraising staff annually

And finally improve the waiting time by analyzing Cause-effect (fish-bone) for managing the factors effecting the time.

6. Study Limitations

This study has some limitations. First the study did not consider the presence of unmeasured confounders relevant to satisfaction, such as severity of illness, comorbidities, date or time of ED visit in vacations holydays etc.., or the atmosphere of the treatment space. Second, the education level of the parents and patients who participated was not analyzed to evaluate its impact on satisfaction level. Third performing the questionnaire in only two emergency departments. Lastly the severity of the attending patients was not evaluated and though its impact on performance and satisfaction.

7. Conclusion

The study was concerned to discuss common problems at emergency departments related to patient's satisfaction. Positive overall satisfaction ratings for the ED were the respecting of patients, their families and nursing care about treatment. While their recommendation of improvement in adult ED training of physician, additionally modifying the procedures and staff skills at pediatric ED.

Acknowledgments

Authors would like to thank those patients who took part in this study. They also appreciate the cooperation of ED staff members of Mansoura and Bannha hospital and prof. Wafaa Salem and Dr. Yasmeen Adel. On another hand MUST university consultants who participated in validation of the Arabic version of the questionnaire

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project is supported by personal financing rather than funding from official agencies.

References