Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study

Emergency patients' satisfaction with humanistic caring and its associated factors in Chinese hospitals: a multi-center cross-sectional study

Purpose

Humanistic caring in clinical practice is important for quality care and patient satisfaction. This study aimed to assess patient satisfaction with humanistic care for emergency patients in China and its associated factors.

Methods

From October 2023 to December 2023, a multi-center cross-sectional survey was conducted across 28 provinces and 87 hospitals in China, using a sampling method for inpatients in emergency department. Patient satisfaction with humanistic care was evaluated by a self-developed questionnaire with 32 items across 6 dimensions. Stepwise multiple linear regression was used to explore associated factors.

Results

A total of 3,003 valid questionnaires were successfully collected, with an effective rate of 86.05%. The emergency patients' total mean humanistic caring satisfaction score was 4.67 ± 0.66. Age, medical insurance type, specialized emergency department visited, waiting times, whether had accompanied person, hospital level, and hospital type are correlated factors (P < 0.05) regarding humanistic caring satisfaction. The correlation analysis showed perceived value, and its three dimensions were moderately correlated with humanistic caring satisfaction. The multiple linear regression showed waiting time (β = -0.219, P < 0.05), whether had accompanied person (β = -0.192, P < 0.05), hospital level (β = -0.137, P < 0.05), functional value (β = 0.197, P < 0.05), and emotional value (β = 0.418, P < 0.05) were strong predictors.

Conclusion

Hospitals at all levels should improve patients' perceived value, shorten waiting times, and provide caregivers with improved humanistic care in the emergency department.

Patient experience of emergency department triage: An integrative review

BACKGROUND

Emergency department (ED) triage is often patients' first contact with a health service and a critical point for patient experience. This review aimed to understand patient experience of ED triage and the waiting room.

METHODS

A systematic six-stage approach guided the integrative review. Medline, CINAHL, EmCare, Scopus, ProQuest, Cochrane Library, and JBI database were systematically searched for primary research published between 2000-2022 that reported patient experience of ED triage and/or waiting room. Quality was assessed using established critical appraisal tools. Data were analysed for descriptive statistics and themes using the constant comparison method.

RESULTS

Twenty-nine articles were included. Studies were mostly observational (n = 17), conducted at a single site (n = 23), and involved low-moderate acuity patients (n = 13). Nine interventions were identified. Five themes emerged: 'the who, what and how of triage', 'the patient as a person', 'to know or not to know', 'the waiting game', and 'to leave or not to leave'.

CONCLUSION

Wait times, initiation of assessment and treatment, information provision and interactions with triage staff appeared to have the most impact on patient experience, though patients' desires for each varied. A person-centred approach to triage is recommended.

Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study

BACKGROUND

Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme.

OBJECTIVE

We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh.

METHODS

A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed.

RESULTS

We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services.

CONCLUSIONS

More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.

Moderating effects of psychological factors and frequency of experiences in the emergency department: The role of perceived quality of healthcare

The aim of this study is to identify the main moderators in the relationship between antecedents/predictors (doctors, privacy, accessibility, and availability, perceived waiting time to be called back by the doctor after the examinations and/or tests) and the perceived quality of healthcare (PQHC) in the emergency department (ED). Patients admitted to the ED of a public hospital in Lisbon, Portugal, between January and December 2016 were included in this study, with a representative sample size of 382 patients. A 5% margin of error and a 95% confidence interval were used, and all data were collected between May and November 2017. We used a stepwise multiple linear regression analysis to test the moderation models. We identified 3 main moderators with different moderating roles between the antecedents (predictors) and PQHC: level of life satisfaction, level of happiness, and frequency of ED experiences. Overall satisfaction with doctors is more likely to influence the PQHC among patients with lower levels of life satisfaction. Moreover, privacy and perceived waiting time to be called back by the doctor after an examination and/or test are more likely to influence the PQHC among patients with lower levels of life satisfaction and happiness. Finally, accessibility and availability are more likely to influence the PQHC among patients with more frequent ED experiences. Thus, knowing the moderating effects of psychological factors and the frequency of ED experiences may help to better understand the relationship between PQHC and certain predictors.

Patients' Satisfaction With the Quality of Services at Primary Healthcare Centers in Saudi Arabia

BACKGROUND

Patients' satisfaction is an essential indicator used to measure the quality of healthcare services. The evaluation of patients' satisfaction with primary healthcare center (PHC) visits is therefore essential when it comes to assessing the quality of healthcare services provided.

AIM

To assess patients' overall satisfaction with the quality of services provided at PHCs in different regions of Saudi Arabia.

METHODS

A retrospective cross-sectional study was conducted using secondary data collected from 2,390 PHCs in different regions of Saudi Arabia. Data were collected by the Patient Experience Measurement Program in the Ministry of Health (MOH) using the Press Ganey Survey from January 2022 to December 2022. The Press Ganey Survey is a standardized tool used by the Saudi MOH to assess patients' satisfaction with the health services provided in different specialties and healthcare facilities. The assessment tool (Press Ganey survey) involves six domains (Access, Moving through, Nurse, Care provider, Personal issue, and Overall assessment). The data were tabulated and analyzed using the Statistical Package for the Social Sciences (SPSS).

RESULTS

In total, there were 536,406 study participants, with their mean age being 28.7±21.1. The overall patients' satisfaction score was 4.2 out of 5 (83.8%). Male participants reported more satisfaction with PHC services than did females (86.6%, 81%), respectively. The domain with the highest patients' satisfaction scores was that of the Care provider (84.8%), while the domain with the lowest rating was Moving through (82.8%).

CONCLUSION

This baseline study found that patients were generally satisfied, with the highest levels of satisfaction with their care providers, highlighting the crucial role of professionals in the patient experience. Further research is recommended to give a more in-depth analysis and thus highlight additional correlating and predicted elements of patients' satisfaction with PHC treatments in Saudi Arabia.

Association of patient experience and the quality of hospital care

The association between patient experience and the quality of hospital care is controversial. We assess the association between clinical outcomes and patient-reported experience measures (PREMs) in hospitals in Saudi Arabia. Knowledge on this issue informs value-based health-care reforms. A retrospective observational study was conducted in 17 hospitals in Saudi Arabia during the period of 2019-22. Hospital data were collected on PREMs, mortality, readmission, length of stay (LOS), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection. Descriptive analysis was used to describe hospital characteristics. Spearman's rho correlation tests were used to assess the correlation between these measures, and multivariate generalized linear mixed model regression analysis was used to study associations while controlling for hospital characteristics and year. Our analysis showed that PREMs were negatively correlated with hospital readmission rate (r = -0.332, P ≤ .01), LOS (r = -0.299, P ≤ .01), CLABSI (r = -0.297, P ≤ .01), CAUTI (r = -0.393, P ≤ .01), and surgical site infection (r = -0.298, P ≤ .01). The results indicated that CAUTI and LOS converged negatively with PREMs (β = -0.548, P = .005; β = -0.873, P = .008, respectively) and that larger hospitals tended to have better patient experience scores (β =0.009, P = .003). Our findings suggest that better performance in clinical outcomes is associated with higher PREM scores. PREMs are not a substitute or surrogate for clinical quality. Yet, PREMs are complementary to other objective measures of patient-reported outcomes, the process of care, and clinical outcomes.

Satisfaction of Clinical Waiting Time in Ear, Nose & Throat Departments of the Ministry of Health in Jeddah, Saudi Arabia

Patient satisfaction is a critical indicator for assessing the quality of healthcare services, as it plays a crucial role in ensuring the effective, timely, and patient-centered delivery of high-quality healthcare. Additionally, patient satisfaction has a direct relationship with clinical outcomes. The objective of this study was to investigate the influence of clinic waiting time on patient satisfaction in an Ear Nose Throat (ENT) outpatient department. A total of 241 patients who visited hospitals and ENT outpatient departments in Jeddah were recruited for this cross-sectional study. Descriptive statistical analysis was performed using IBM SPSS version 25. The majority of patients expressed satisfaction with the waiting time at the clinic. Additionally, many patients reported being satisfied with the handling of appointments and the information they received from their friends or relatives. Significant statistical differences were observed between waiting time and demographic factors such as age, gender, employment status, and residence. Moreover, there was a statistically significant association between patient satisfaction with the appointment process and the information provided by the staff (P-value < .001). Notably, patients visiting the ENT outpatient department exhibited higher satisfaction scores. These findings hold the potential for informing quality improvement initiatives. Furthermore, it is recommended that future studies be conducted to assess patient satisfaction and provide valuable insights to policymakers and clinicians when making decisions related to healthcare delivery.

Engaging, empowering and educating the waiting patient

While emergency departments are open to anyone without appointment, the need for prioritisation results in periods of waiting that are both wasteful and frustrating. However, value can be added to patient care by (1) engaging the waiting patient, (2) empowering the waiting patient and (3) educating the waiting patient. If these principles are implemented, they will benefit both the patient and the healthcare system.

Patient Satisfaction With Quality of Care at the Kingdom of Saudi Arabia

Background The emergency department (ED) is the first contact of many individuals who require acute health services. This study was the first to be conducted among patients in different regions of Saudi Arabia to determine patient satisfaction with emergency healthcare services using the Arabic version of the Echelle de Qualité des Soins en Hospitalisation (EQS-H). Methodology This cross-sectional study was conducted among 2,997 patients admitted to the ED in different hospitals in different regions of Saudi Arabia. The study was based on a self-reported questionnaire validated to assess the satisfaction of patients with ED healthcare services called EQS-H. In this study, we used an Arabic version of the questionnaire. Statistical analyses were performed using R version 3.6.3. Results The study was conducted among 2,997 patients (36.7% males and 63.3% females). Regarding region, respondents from the central region represented one-third of the sample (31.7%), followed by respondents from the western, eastern, and southern regions (24.1%, 16.9%, and 14.6%, respectively). Statistical analysis showed that the average percentage score for the clarity of information was significantly higher in the central region than in other regions and was lowest in the eastern region. Individuals aged 26-35 years (B = -2.54 and P < 0.05), male sex (B = -1.63 and P < 0.05), Saudis (B = -3.81 and P < 0.05), longer ED length of stay (LOS) (B = -2.19 and P < 0.001), worse perceived health state, and lower life satisfaction scale scores were significantly associated with lower levels of satisfaction with ED services. Perceived improvement is the strongest predictor of satisfaction. Conclusion Moderate satisfaction levels were reported in both the clarity of information domain and relationship with staff domain among patients admitted to EDs in different regions of Saudi Arabia, with better results in the central region.

Personalized Communication with Patients at the Emergency Department—An Experimental Design Study

Communication of clinicians at the emergency department is a barrier to patient satisfaction due to lack of human connection, lack of control over the situation, low health literacy, deficient information, poor support at a time of uncertainty all affecting perceived quality of care. This explorative study tests drivers of patient satisfaction with communication of clinicians at the emergency department. The sample comprises 112 Americans from the New York greater area, who visited an emergency department in the past year. A conjoint-based experimental design was performed testing six messages in six categories. The categories encompass acknowledged aspects of communication with health providers enabling to compare among them when exploring communication at the ED by patient preferences. Respondents rated messages by the extent to which it drives their satisfaction with communication of clinicians at the emergency department. Based on the similarity of patients’ response patterns to each message, three significantly distinct mindsets of patient preferences regarding communication exchanges with clinicians at the emergency department emerged. Different conduct and communication messages drive the satisfaction of members of each mindset with the communication of clinicians at the emergency department. The strong performing messages for one mindset are irrelevant for members of other mindsets. Clinicians may identify the patient-belonging to a mindset and communicate using mindset-tailored messages. This novel strategy may enable clinicians to implement patient-centered communication, by mindset, promoting patient satisfaction and enabling clinicians to better cope with patients in the chaotic emergency department environment.

Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05–3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03–3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04−2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.

Patient Satisfaction of Ambulatory Care Pharmacy Services

The Ministry of Health (MOH) recently developed the Health Sector Transformation Program (HTSP) to focus on patient satisfaction, safety, and care. This study explored patient satisfaction with outpatient care services.

A semi-structured questionnaire was designed to collect the data of patient satisfaction with pharmacy care services through face-to face interviews of participants and over the internet using an electronic format of the same questionnaire (web-based survey).

A total of 508 participants responded of whom, 51.8% were male and 83% were below 46 years old. The average scores of domains 1, 2, 3, 4, 5, 6, 7, and 8 were 4.51, 4.11, 4.30, 3.70, 3.57, 3.82, 3.63, and 4.15, respectively. The general evaluation of pharmacy services demonstrated that respondents were very satisfied (245; 48.2%), satisfied (143; 28%), and willing to recommend the pharmacy to their families (380; 76.4%). There was no statistically significant difference in the overall satisfaction with pharmacy services among the 2 hospitals (P > .05).

Most respondents were satisfied with outpatient care pharmacy services. More efforts are needed to improve the service of following up on patients’ adherence by the pharmacists.

The end-of-life care in the emergency department setting with respect to the Middle East countries and comparison with the Western countries

Patients who are affected with severe chronic illness or in need for end-of-life care ((EOLC), they are mainly treated in the emergency departments (EDs) to provide the utmost amount of care for their condition. The major aspects which impact the accessibility of care in the ED include the clinical, social, and economic factors in different regions of countries. In recent years as the EOLC has been provided, it has been observed that patients experiencing EOL and dealing with a dying process do not always achieve the experience what resonates with a good death. The main cause of concern for these patients is the problem that in the ED they do not have access to palliative care options, mainly the ones who are suffering from noncancer ailments. These patients are provided palliative care at a very later stage in the ED when they could have been provided with palliative management at home in an earlier manner. EOLC plays a very critical role in ensuring that terminally ill patients are given a proper and adequate amount of care. The present article aims to highlight the EOLC in the ED in the Middle-Eastern regions. We aim to present a broader view that has impacted the current situation of EOLC in the Middle East regions and demonstrate a description of the EOLC in an ED setting between the Middle Eastern regions and western culture focusing on the following five important factors: Situation acceptance in the ED, cultural compatibility of bioethics, treatment perspective, skills among clinical providers and physician's attitude. In this literature review, we present the evidence associated with the EOLC in the ED setting with respect to the Middle East countries and bring out their differences in the religious, clinical, social, ethical, and economic aspects in comparison with the Western countries. We also tried to determine the differences between the two regions in terms of the principle of explaining the fatal diagnosis or poor prognosis, family relations, and do-not-resuscitate decision. This comparative analysis will help to bring out the gaps in the quality of care in the ED in the Middle East countries and promote the development of well-assessed policies and strategies to improve EOLC. The findings of this study and the future interventions that can be implemented to improve the structure and design of the EOLC that will act as a guiding force to execute evidence-based quality improvement program.

Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

Objective

Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting.

Methods

We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores.

Results

We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05).

Conclusion

Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.

Impacto de la aplicación de medidas de humanización en unidades de hemodiálisis

Introducción: El papel de la Enfermería Nefrológica en el cuidado y atención humanizada de los pacientes en hemodiálisis es fundamental. Objetivos: Analizar la satisfacción percibida por pacientes y profesionales sanitarios de unidades de hemodiálisis tras la implementación de un programa para potenciar la humanización de la asistencia. Material y Método: Estudio analítico longitudinal prospectivo cuasiexperimental con grupo control histórico. La recogida de datos se realizó en un periodo de 13 meses en 16 centros de la Fundación Renal Íñigo Álvarez de Toledo, a un total de 667 pacientes y 180 trabajadores. Se emplearon dos cuestionarios autoadministrados, uno para pacientes y otro para profesionales. Resultados: Tras la implantación del programa, el número de pacientes que considera que el personal siempre les informa sobre los procedimientos aumentó de forma significativa (p=0,043) y un 62,4% de los pacientes valoró como importante que pueda entrar algún familiar o persona cercana durante la sesión. Tras la implantación del proyecto, el 49,2% de los profesionales sanitarios consideraron siempre necesaria la formación en el ámbito de la humanización y opinaban que sería conveniente mejorarla (p>0,005). Conclusiones: Se ha advertido un incremento significativo en la satisfacción de los pacientes respecto a la información proporcionada por los profesionales y la cercanía de éstos. Se han verificado valores muy positivos respecto al trato humanizado que reciben los pacientes y su comodidad durante las sesiones de hemodiálisis. Por otra parte, los profesionales consideran necesaria la formación en el ámbito de la humanización y creen que sería conveniente mejorarla en las unidades.

Assessment patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia

BACKGROUND

As the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from March 1-30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant.

RESULTS

A total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively.

CONCLUSIONS

The total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.

Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia

Background

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Level of patients' satisfaction is an important health outcome, which is regarded as a determinant measure for quality of care. This study was performed with the aim of assessing the level of patient satisfaction with inpatient services and its determinants in Black Lion Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from November 25th to December 20th, 2015, using 398 randomly selected patients. Ethical clearance was obtained from the Jimma University research review board, and verbal consent was also received from the study participants during data collection time. A pretested structured interview questionnaire was used to collect data from study participants. The collected data were handled by using SPSS statistical software. Before analysis, relevant explanatory variables were identified using factor analysis with varimax rotation, and bivariate analysis was carried out using linear regression for every independent variable with the outcome variable independently. Explanatory variables scoring p value <-0.05 were used for the final model after checking the assumption. Study findings are presented by using tables, graphs, and description.

Results

A total of 398 patients were participated in the study, yielding a response rate of 100%. A total of 46.2% (95% CI: 41.2%-51.1%) patients were satisfied by the services they received in the hospital. Patient and health care provider interaction and general facility amenity-related domains were found to explain 96.4% of the variability in the net overall satisfaction score. Good quality services provided by hospital physicians, availability of laboratory and radiology services, pain management services, and inpatient pharmacy services of the hospital had positive influences. Besides toilet cleanliness, availability of rooms for accommodation and dietary service had significant relation with level of patient satisfaction. Quality of the inpatient pharmacy service had a great influence on satisfaction; a unit increase in it resulted in 2.3 (95% CI: 2.1-2.5) times increment in patient satisfaction level at p ≤ 0.001. For final predictors, regression estimates for level of satisfaction moved from very dissatisfied to very satisfied when service improves by a unit.

Conclusion

Overall patients' satisfaction is lower than other studies in the nation. A great opportunity is there to improve patient's satisfaction level if the service quality is improved around the time of patient and health care provider interaction and facility amenity services. Besides, improving the health literacy of service providers and devising a strategy to routinely assess satisfaction level of patients in the facility is critical. On top of this, providing tailored on-the-job training for health care workers in the facility is a crucial step in order to improve their knowledge and skills to render patient-centered quality service to improve their patients' satisfaction. Using a checklist during service delivery may improve client patient interaction and ensure the standard. Facility design dimension can be considered for future research activities.

Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children

BACKGROUND

Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews.

METHODS

Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach.

RESULTS

Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources.

CONCLUSION

This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.

Effect of waiting time estimates on patients satisfaction in the emergency department in a tertiary care center

OBJECTIVES

To examine the influence of emergency department (ED) waiting time estimate provision on the satisfaction of patients.  Methods: This was a randomized controlled trial at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September 2017 and May 2018. It included 18 to 70 years old Arabic-speaking acute care patients. After being divided into 2 groups, the intervention group alone was provided waiting time estimates. Both groups answered 2 questionnaires evaluating their satisfaction and illness perception before and after seeing a doctor. Results: One-hundred patients were included. No significant difference found in waiting time satisfaction scores between groups (intervention (5.92/10±3.13), control (5.45/10±3.38), p=0.476). Demographics and illness perception had an insignificant impact on satisfaction. Waiting time estimate was preferred by most participants (70%). Conclusion: Providing waiting time estimation did not affect satisfaction but was preferred to have in the ED by most.

Relationship Between Patient Satisfaction and Willingness to Comply With Physicians' Recommendation in Referral Surgical Outpatient Clinic in Nigeria

The relationship between patient satisfaction with surgical care and their willingness to comply with doctors’ recommendations has not been studied in the country. This study determined the relationship between ambulatory patients’ satisfaction with care and their willingness to adhere to the surgeons’ recommendations in the surgical outpatient clinic (SOPC) of the University Teaching Hospital. This analytical cross-sectional study was conducted among 490 adult respondents at the SOPC selected through a systematic sampling method with a sample interval of 1:2. The short form of the Patient Satisfaction Questionnaire with 7 domains and tool developed for patient willingness to comply with surgeons’ recommendations were used. Descriptive and inferential analyses were performed, and P values of <.05 were considered significant. A total of 466 respondents’ data were analyzed, giving a response rate of 95.1%. About 52.8% were males and 47.2% were females. The associations between domains of patient satisfaction and willingness to surgical instructions were mostly weak and nonsignificant. Their satisfaction with communication with the surgeons was the most consistent predictor of patient willingness and showed significant relationships with their willingness to accept follow-up visits (P = .002), drug prescription (P < .001), and further investigation (P < .001). Access/convenience and general satisfaction were significantly associated with their willingness to recommend the surgery clinic to close friends and relatives. Patient satisfaction with care has a significant relationship with their willingness to adhere to surgical recommendations.

The Impact of Service Quality on Patient Satisfaction and Revisiting Intentions: The Case of Public Emergency Departments

BACKGROUND AND OBJECTIVES

This study attempts to (a) identify the main quality indicators that affect "service quality" and (b) examine the effect of "patient satisfaction" on patient "revisiting intentions."

METHODS

The sample includes patients of 2 hospitals, 1 urban and 1 provincial. The comparative analysis of 2 emergency departments (EDs) with different characteristics aims at understanding their diverse problems and their specific needs from a patient point of view. Empirical data were collected in the fall of 2015. Three hundred questionnaires were distributed in person. A total of 169 valid questionnaires, 80 from hospital A and 89 from hospital B, were returned, with a response rate of 56.3%.

RESULTS

The Structural Equation Modeling technique revealed that overall satisfaction is strongly influenced by "perceived service quality" (β = .79), while it positively affects patient "behavioral intentions" (β = .39). Also, "perceived waiting time" proved to have a more intense impact on "perceived service quality" (β = -.59), rather than on "perceived technical and functional quality" (β = .18). Moreover, it was determined that patients visiting the urban ED pay more attention in waiting times, while patients visiting the provincial ED care about receiving both quality and timely health care services. Overall, the study provides insight about the main factors affecting "perceived service quality" and "overall satisfaction." These factors fall into 2 distinct categories: "perceived technical and functional quality" and "perceived waiting time."

CONCLUSIONS

The study concludes that "overall satisfaction" acts as a mediator between "perceived service quality" and patient "behavioral intentions," while "perceived waiting time" is the most significant indicator of service quality and the most crucial predictor of ED patient satisfaction. Moreover, it offers empirical evidence concerning the differences in the way patients rate the services offered by a hospital, based on the hospital size and the region it is located (urban or provincial).

The Buffering Effect of Humanity of Care in the Relationship between Patient Satisfaction and Waiting Time: A Cross-sectional Study in an Emergency Department

This study aims to examine whether humanity of care and environmental comfort played a role in moderating the relationship between waiting time and patient satisfaction in an emergency department (ED). The study used a cross-sectional and non-randomized design. A total of 260 ED patients in two hospitals in Italy completed a self-report questionnaire. Moderated regression showed that after adjusting for control variables, waiting time was significantly and inversely associated with patient satisfaction. Humanity of care and environmental comfort showed a positive and significant association with patient satisfaction. Finally, the interaction term between waiting time and humanity of care was found to be significant, whereas the interaction effect between waiting time and environmental comfort was not significant. The conditional effect showed that when humanity of care was low, waiting time was negatively and significantly related to patient satisfaction. By contrast, when humanity of care was medium and high, the relationship between waiting time and patient satisfaction was not significant. These findings shed light on the key role of humanity of care in moderating the relationship between waiting time and patient satisfaction. The complex interrelations emerged should be carefully considered when interventions to foster patient satisfaction in an ED context are planned.

Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study

OBJECTIVES

To keep healthcare systems sustainable for future demands, many countries are developing a centralised telephone line for out-of-hours primary care services. To increase the quality of such services, more information is needed on factors that influence caller satisfaction. The aim of this study was to identify demographic and call-related characteristics that are associated with the patient satisfaction of callers to a medical helpline in Denmark.

DESIGN

Retrospective cohort study on patient registry data and questionnaire results.

SETTING

Non-emergency medical helpline in the Capital Region of Denmark.

PARTICIPANTS

A random sample of 30 402 callers to the medical helpline between May 2016 and May 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Responses of a satisfaction questionnaire were linked to demographic and call-related dispatch data. Associations between the characteristics were analysed with multivariable logistic regression analysis with satisfaction as the dependent variable. A subgroup analysis was performed on callers for children aged between 0 and 4 years.

RESULTS

Of the 30 402 analysed callers, 73.0% were satisfied with the medical helpline. Satisfaction was associated with calling for a somatic injury (OR: 1.96, 95% CI: 1.72 to 2.23), receiving a face-to-face consultation (OR: 2.27, 95% CI: 2.04 to 2.50) and a waiting time less than 10 min (OR: 1.82, 95% CI: 1.56 to 2.08). Callers for a 0-year to 4-year-old patient were more likely to be satisfied when they called for a somatic illness or received a telephone consultation, compared with the rest of the population (p<0.0001).

CONCLUSION

Callers were in general satisfied with the medical helpline. Satisfaction was associated with reason for encounter, triage response and waiting time. People calling for 0-year to 4-year-old patients were, compared with the rest of the population, more frequently satisfied when they called for a somatic illness or received a telephone consultation.

Factors Associated With Patient Satisfaction in Outpatient Department of Suva Sub-divisional Health Center, Fiji, 2018: A Mixed Method Study

Background: With evolving health care industry toward patient centered orientation, inputs from the patients' perspective is valuable. Improved patient satisfaction is associated with increased levels of adherence to treatment processes and recommended prevention, and improved health outcomes. Hence, this study was conducted to assess the current level of patient satisfaction and explore its determinants in the Suva Subdivision health centers, Fiji, 2018.

Methods: This was a mixed method cross-sectional study employing both quantitative and qualitative designs. A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The questionnaire focused on socio-demographic features, waiting time, doctors' communication, and patient trust. Data from 375 questionnaires (response rate of 91%) was analyzed in SPSS where descriptive analysis and univariate and multivariate logistic regression was done at 0.05 level of significance and 95% confidence interval to find the determinants of patient satisfaction. From these 375 participants, 20 participants were purposefully selected for audio recorded interview guided by a semi-structured questionnaire and data was analyzed using thematic analysis.

Results: The majority of the patients were generally fully satisfied with their consultation (69.3%). Univariate logistic regression showed that age, gender, education level, waiting time, doctors' communication behavior, and patient trust level were significantly associated with patient satisfaction independently. After controlling for all the variables, gender, number of visits, waiting time, and patient trust were significantly associated with trust. Those who had full trust in the doctors, were more likely to be fully satisfied with their consultation (aOR of 18; p = 0.0001) and those who got seen within 1 h, were more likely to be satisfied with their consultation (aOR of 3.3; p = 0.0001). Though, the patients voiced that getting a satisfying consultation was worth the wait. The doctors' attitude and way of communication also made a difference to the patient's level of satisfaction.

Conclusions: This study showed that patient satisfaction is positively associated with patient trust, doctors' interpersonal skills and communication behavior and negatively associated with waiting time. Hence, doctors upgrading their communication skills and health service managers strategizing ways to improve waiting time can contribute to better patient trust and thus lead to better patient satisfaction and positively influence health outcomes.

Humanization in urgent and emergency services: contributions to nursing care

OBJECTIVE

To analyze the evidence of researches carried out on humanization in urgent and emergency care, considering their contributions to nursing care.

METHODS

Integrative review of LILACS, CINAHL, SciELO, Web of Science, SCOPUS, and BDENF databases, using the keywords: humanization of care, urgencies, emergencies, emergency medical services, and nursing.

RESULTS

The search resulted in a total of 133 publications, of which 17 were included in the scope of this review. The analysis enabled the elaboration of the evidence units: 'Reception with Risk Classification: a device with good results' and 'Barriers and difficulties to use the guidelines of the National Humanization Policy'.

CONCLUSION

The Reception with Risk Classification was evidenced as the main device for the effective implementation of the National Humanization Policy and there are barriers to its effectiveness related to the organization of health care networks, structural problems, and multi-professional work.

Assessing bottlenecks in Emergency Department flow of patients with abdominal pain

INTRODUCTION

Abdominal pain has a wide range of possible causes, which may lead to difficulties in diagnosing and lengthy Emergency Department (ED) stays. In this study, bottlenecks in ED processes of patients with abdominal pain were identified.

METHODS

Time-points of patients who presented to a Dutch ED with abdominal pain were observed and documented. The institutional review board approved the study.

RESULTS

In total, 3015 min of patient time were observed in 54 patients. Median length of stay (LOS) was 218 min for admitted patients, and 168 min for discharged patients. For 65 patients (27.4%), LOS exceeded 4 h. Delays were found during the diagnostic process, when multiple physicians were needed in order to make a decision, and during departure.

CONCLUSIONS

Our study concerning individual patients' time-points provides important insight into delays in the patient journey of patients with abdominal pain. Flow improvement can be achieved by focusing on these bottlenecks, for example by minimizing diagnostic delays and by simultaneous specialists' consultations for patients who need more than one physician. The optimization of ED flow for patients with abdominal pain depends on coordinated efforts between ED staff, medical specialists, radiology and laboratory staff, staff from inpatient units, and hospital supporting services.

Contextual and individual factors associated with dissatisfaction with public emergency health services in Brazil, 2011-2012

The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman’s office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care’s waiting time and the length needed to resolve the demand.