Impact of patient and family communication in a pediatric emergency department on likelihood to recommend

N. S, Clerc P, Carciumaru R, Alqurashi W, Rajagopal M, Kammerer E, Leung J, Wright B, Scott SD. Family caregivers' emotional and communication needs in Canadian pediatric emergency departments

OBJECTIVES

To describe the extent to which caregivers' emotional and communication needs were met during pediatric emergency department (PED) visits. Secondary objectives included describing the association of caregiver emotional needs, satisfaction with care, and comfort in caring for their child's illness at the time of discharge with demographic characteristics, caregiver experiences, and ED visit details.

STUDY DESIGN

Electronic surveys with medical record review were deployed at ten Canadian PEDs from October 2018 -March 2020. A convenience sample of families with children <18 years presenting to a PED were enrolled, for one week every three months, for one year per site. Caregivers completed one in-PED survey and a follow-up survey, up to seven days post-visit.

RESULTS

This study recruited 2005 caregivers who self-identified as mothers (74.3%, 1462/1969); mean age was 37.8 years (SD 7.7). 71.7% (1081/1507) of caregivers felt their emotional needs were met. 86.4% (1293/1496) identified communication with the doctor as good/very good and 83.4% (1249/1498) with their child's nurse. Caregiver involvement in their child's care was reported as good/very good 85.6% (1271/1485) of the time. 81.8% (1074/1313) of caregivers felt comfortable in caring for their child at home at the time of discharge. Lower caregiver anxiety scores, caregiver involvement in their child's care, satisfactory updates, and having questions adequately addressed positively impacted caregiver emotional needs and increased caregiver comfort in caring for their child's illness at home.

CONCLUSION

Approximately 30% of caregivers presenting to PEDs have unmet emotional needs, over 15% had unmet communication needs, and 15% felt inadequately involved in their child's care. Family caregiver involvement in care and good communication from PED staff are key elements in improving overall patient experience and satisfaction.

Caregiver Satisfaction with Emergency Department Care for Pediatric Patients with Neurodevelopmental Disorders

OBJECTIVE

Children with neurodevelopmental disorders (NDDs) often encounter increased adversity when navigating the health care system. In this study, we explored the pediatric emergency department (PED) experience for patients with NDDs and their caregivers compared with that of patients without NDDs.

METHODS

Data for this study were obtained from National Research Corporation patient experience survey questionnaires and electronic medical record (EMR) data for patients presenting to a PED between May 2018 and September 2019. ED satisfaction was determined by the top-box approach; ED ratings of 9/10 or 10/10 were considered to reflect high ED satisfaction. Demographics, Emergency Severity Index, ED length of stay, time from arrival to triage, time to provider assessment, and diagnoses were extracted from the EMR. Patients with NDDs were identified based on International Classification of Diseases, Tenth Revision codes; patients with intellectual disabilities, pervasive and specific developmental disorders, or attention-deficit/hyperactivity disorders were included in the NDD cohort. One-to-one propensity score matching between patients with and without NDDs was performed, and a multivariable logistic regression model was built on the matched cohort.

RESULTS

Patients with NDDs represented over 7% of survey respondents. Matching was successful for 1162 patients with NDDs (99.5%), resulting in a matched cohort sample size of 2324. Caregivers of patients with NDDs had 25% lower odds of reporting high ED satisfaction (95% confidence interval [CI], 0.62-0.91, p = 0.004).

CONCLUSION

Caregivers of patients with NDDs make up a significant proportion of survey respondents and are more likely to rate the ED poorly than caregivers of patients without NDDs. This suggests an opportunity for targeted interventions in this population to improve patient care and experience.

Care to Share? Patients in Private Rooms Are More Likely to Recommend a Hospital to Others

A patient's likelihood to recommend a hospital is used to assess the quality of their experience. This study investigated whether room type influences patients' likelihood to recommend Stanford Health Care using Hospital Consumer Assessment of Healthcare Providers and Systems survey data from November 2018 to February 2021 (n = 10,703). The percentage of patients who gave the top response was calculated as a top box score, and the effects of room type, service line, and the COVID-19 pandemic were represented as odds ratios (ORs). Patients in private rooms were more likely to recommend than patients in semi-private rooms (aOR: 1.32; 95% CI: 1.16-1.51; 86% vs 79%, p < .001), and service lines with only private rooms had the greatest increases in odds of a top response. The new hospital had significantly higher top box scores than the original hospital (87% vs 84%, p < .001), indicating that room type and hospital environment impact patients' likelihood to recommend.

Using an electronic discharge process to improve patient experience and timeliness in a pediatric urgent care setting

BACKGROUND

Most patients in acute care settings are discharged home. Time waiting for discharge paperwork does not add value to patient experience. Quality discharge counseling is critical for patient experience and safety.

OBJECTIVE

To increase online portal enrollment in order to decrease length of stay through use of an electronic discharge (e-discharge) process.

PATIENT INVOLVEMENT

We used patient tracers to evaluate the perception of the UC discharge process at baseline, which helped identify barriers to signing up for the patient portal.

METHODS

We performed a manual audit of patient encounters twice a month (N = 1431) to determine rate of portal enrollment, e-discharge, and LOS. We calculated summary distributions of LOS for those that received hardcopy vs. e-discharge instructions. We measured the percentage of positive scores for overall experience and quality of anticipatory guidance for all completed surveys.

RESULTS

For audited encounters portal enrollment increased from 22% to 37% (p < 0.001). Encounters with e-discharge instructions had a shorter median LOS compared to patient encounters that received hardcopy instructions (55.0 vs. 68.0 min; p < 0.001). There was no difference in overall rating or perceived quality of anticipatory guidance between groups.

DISCUSSION

Patients who received e-discharge instructions had significantly shorter LOS compared to those who received hardcopy instructions. The overall rating and perceived quality of anticipatory guidance were not negatively affected by e-discharge instructions.

PRACTICAL VALUE

Enrolling children into an online portal requires additional steps to ensure that only patients and their legal guardians have access to protected patient information. However, the benefits of offering the portal include shorter LOS without impacting the perceived quality of discharge counseling.

FUNDING

Children's Mercy supported all phases of this study.

The Impact of Diagnostic Decisions on Patient Experience in the Pediatric Emergency Department

OBJECTIVE

Patient experience serves as both a subjective measure of value-based health care delivery and a metric to inform operational decision making. The objective of this study was to determine if specific diagnostic and therapeutic interventions affect patient experience scores for children seen in the emergency department.

METHODS

We performed a retrospective observational study in the emergency department of a large quaternary care children's hospital on patients who were discharged to home and later completed a National Research Corporation Health patient experience survey. We matched the survey results to electronic health record (EHR) data and were able to extract demographics, operational metrics, and order information for each patient. We performed multiple logistic regression analyses to determine the association of image acquisition, laboratory test ordering, medication administration, and discharge prescribing with likelihood to recommend the facility as our measure of patient experience.

RESULTS

Of the 4103 patients who met inclusion criteria for the study, 75% strongly recommended the facility. Longer wait times were associated with lower patient experience scores [odds ratio (OR) per waiting room hour increase, 0.72; 95% confidence interval (CI), 0.65-0.81]. Significant diagnostic factors associated with higher patient experience included magnetic resonance imaging ordering (OR, 2.38; 95% CI, 1.00-5.67), x-ray ordering (OR, 1.19; 95% CI, 1.00-1.42), and electrocardiogram ordering (OR, 1.62; 95% CI, 1.07-2.44). Of the treatment factors studied, only antibiotic prescribing at discharge was found to have a significant positive association with patient experience (OR, 1.32; 95% CI, 1.08-1.63).

CONCLUSION

The positive association between more intensive diagnostic workups and patient experience could have implications on the utility of patient experience scores to evaluate pediatric care teams. Consideration should be taken to interpret patient experience scores in the context of compliance with approaches in evidence-based medicine.

Patient-Reported Experience in the Pediatric Emergency Department: What Matters Most?

INTRODUCTION

Although the Child Hospital Consumer Assessment of Healthcare Providers and Systems is a validated tool for the inpatient experience, it may not address features unique to the pediatric emergency department (PED). There is currently no publicly available validated patient-reported experience survey for the PED, and what matters most in this setting remains unknown.

METHODS

Twelve semistructured interviews were conducted with a convenience sample of parents of children younger than 14 years at a Canadian PED. Data analysis was performed using inductive thematic analysis to identify aspects of patient-reported experiences that matter most to parents in the PED.

RESULTS

Five themes were identified: (1) making waiting a positive experience, (2) taking the time to provide care, (3) forging a positive partnership, (4) speak up for safe care, and (5) making the environment feel safer. Parents highlighted that while waiting for care is not desirable, it is made more acceptable through the communication of wait time estimates and the presence of child activities in the waiting room. Furthermore, although interactions with providers are brief, parents emphasized the importance of creating an environment of partnership with open communication, taking the time to examine their child, and actively demonstrating the provision of safe, quality care.

CONCLUSIONS

Results from this study suggest that a patient-reported experience survey in the PED may need to embed elements not currently captured in Child Hospital Consumer Assessment of Healthcare Providers and Systems, such as waiting room experience, comprehensiveness of health assessments, and observations of safety measures. Future studies can use these findings to develop a patient-reported experience survey for use in the PED.

How to improve patient satisfaction behavioral compliance and hospital image through nurse caring: Strategizing for healthcare during COVID-19

We investigated the impact of nurse caring on patient satisfaction, behavioral compliance, and organization image from a patient's perspective in the private healthcare sector in the Syrian capital-Damascus. The conceptual model can significantly explain 40, 64, and 49% of satisfaction, compliance, and organization image, respectively in a statistical manner. Responsiveness had more influence on patient satisfaction than communication skills. Friendship behavior had no significant effect on satisfaction, and behavioral compliance. The most important aspect that influenced the organization's image was the nurse's communication skills followed by responsiveness and service friendship behavior.

Using Dry-Erase Boards to Share Information in a Pediatric Emergency Department to Improve Family Experience of Care

OBJECTIVES

To determine whether the use of dry-erase boards for communicating the plan of care of children evaluated in the pediatric emergency department (PED) improves the family experience of care.

METHODS

Dry-erase boards were mounted at eye level in patient examination rooms. The study was conducted during a 4-week period during which physicians were instructed to use the boards on alternating weeks. During the 2 intervention weeks, they were instructed to write their name and plan of care in addition to their standard verbal communication. A questionnaire was administered to a convenience sample of caregivers that measured their perceptions of physician listening skills, time spent with the physician, their understanding of the care plan, their willingness to ask questions, likelihood to recommend the PED, and overall physician care. Differences between intervention and nonintervention weeks were analyzed using adjusted multivariable modeling taking into account clustered observations within physician.

RESULTS

Surveys were completed by 672 caregivers. There were no significant differences in reported experience of care between the intervention and nonintervention weeks. During the intervention weeks, 59% of caregivers recalled use of the dry-erase boards, whereas 10% of caregivers recalled use during nonintervention weeks. Caregivers who recalled the use of dry-erase boards were more likely to report better physician listening skills, better understanding of the plan of care, and higher overall physician ratings.

CONCLUSIONS

Recommending use of dry-erase boards in pediatric emergency department rooms did not increase overall measures of experience of care, although patients who recalled dry-erase board use did report higher performance. Further study could explore how to effectively and efficiently use these boards.

Improving Patient Experience Scores in a Pediatric Emergency Department

INTRODUCTION

Patient experience (PE) is an important aspect of the quality of medical care and is associated with positive health outcomes. In the pediatric emergency department (PED), PE is complicated due to the balance of needs between the patient and their family while receiving care. We identified an opportunity to improve our PE, as measured by a survey administered to patients and families following their visit to the PED.

METHODS

Utilizing quality improvement methods, we assembled a multidisciplinary team, developed our aims, and evaluated the process. We utilized a key driver diagram and run charts to track our performance. The team additionally monitored several essential subcategories in our improvement process. We aimed to improve our overall PE score from 86.1 to 89.7 over 9 months to align with institutional objectives.

RESULTS

Over 6 months, we improved our overall PE score from 86.1 to 89.8. Similarly, each of our subscores of interest (physician performance, things for patients to do in the waiting room, waiting time for radiology, staff sensitivity, and communication about delays) increased. Interventions included rounding in the waiting and examination rooms, staff training, team huddles, and a cross-department committee. All measures demonstrated sustained improvement.

CONCLUSIONS

Even in this complex setting, a multidisciplinary team's careful and rigorous process evaluation and improvement work can drive measurable PE improvement. We are continuing our efforts to further improve our performance in excellent patient-centered care to this critical population.

Informing quality in emergency care: understanding patient experiences

PURPOSE

Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED).

DESIGN/METHODOLOGY/APPROACH

The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10).

FINDINGS

Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating.

RESEARCH LIMITATIONS/IMPLICATIONS

Owing to the ED patient's emergency nature, participants were recruited if triaged at levels 3-5 (Manchester Triage System). The study explored patients' immediate rather than post hoc experiences where recollections may change over time.

ORIGINALITY/VALUE

To the authors' knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study

BACKGROUND

Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED).

OBJECTIVE

To compare the care processes of LEP patients in the ED.

DESIGN

Retrospective cohort study.

SETTING

ED in a large tertiary care academic medical center.

PATIENTS

Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care.

MAIN MEASURES

Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED.

KEY RESULTS

We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57).

CONCLUSIONS

ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.

Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea Health Panel Data 2010 to 2012

Objective

We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea.

Methods

This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable.

Results

A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year.

Conclusion

Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted.

Measuring the Correlation Between Emergency Medicine Resident and Attending Physician Patient Satisfaction Scores Using Press Ganey

OBJECTIVE

The purpose of this study was to assess the relationship between emergency medicine (EM) resident and attending physician patient satisfaction scores.

METHODS

We added four resident questions to the standard Press Ganey survey used at a large, urban, university hospital with a PGY-1 to -4 EM residency. The resident questions were identical to the traditional attending questions. Press Ganey distributed the modified survey to a random sample of 30% of discharged patients. We assessed the correlation between resident and attending top-box Press Ganey scores using Pearson's coefficients. Two-tailed two-sample comparisons of proportions were used to compare top-box responses between residents and attendings.

RESULTS

From September 1, 2012, to August 31, 2015, a total of 66,216 patients received surveys, and 7,968 responded, resulting in a 12.03% response rate, similar to Press Ganey survey response rate at comparable peer institutions. Patients were able to discriminate between residents and attendings; however, 751 surveys did not contain responses for residents, resulting in a total number of 6,957. All 64 of the EM residents had a minimum of 5 or more surveys returned. There was a high degree of correlation between resident and attending top-box scores with correlation coefficients ranging from 0.75 to 0.80. However, the proportion of top-box scores was consistently higher for residents (p < 0.05).

CONCLUSIONS

There is a high degree of correlation between resident and attending top-box scores on Press Ganey surveys, with residents scoring slightly higher than attendings. The addition of resident questions to the standard Press Ganey survey does not appear to decrease overall attending scores.

Factors influencing satisfaction with emergency department medical service: Patients' and their companions' perspectives

AIMS

To examine the individual determinants that influence satisfaction with medical services at the emergency department and to compare the factors that influence satisfaction for the patients, compared with their companions.

METHODS

Using data from the 2009 Korea Health Panel Survey, Andersen's behavioral model was used to examine the factors that affect satisfaction with service. A logistic regression analysis was conducted with the data.

RESULTS

Patients who were older, female, and employed were more satisfied with the service, as were patients who visited more frequently and those who had non-surgical treatment. Companions who had less education, were accompanying non-Medicaid-holders, and spent a longer time in the emergency department were less likely to be satisfied. This was in contrast to those who spent a shorter amount of time in the emergency department and who visited due to illness, rather than injury; these companions were more satisfied with the service. When all the factors were analyzed simultaneously, they differed significantly between the two groups of patients and companions.

CONCLUSIONS

Different factors contributed to the satisfaction with the services for the patients and their companions. In order to increase the satisfaction levels and improve the quality of care in emergency departments, it is necessary to consider more specific approaches that reflect the different perspectives of the visitors to the emergency department.

What Parents Want: Does Provider Knowledge of Written Parental Expectations Improve Satisfaction in the Emergency Department?

OBJECTIVE

Satisfaction is an important measure of care quality. Interventions to improve satisfaction in the pediatric emergency department (ED) are limited, especially for patients with nonurgent conditions. Our objective was to determine if clinician knowledge of written parental expectations improves parental satisfaction for nonurgent ED visits.

METHODS

This randomized controlled trial was conducted in a tertiary-care pediatric ED. Parents of children presenting for nonurgent visits (Emergency Severity Index level 4 or 5) were randomized into 3 groups: 1) the intervention group completed an expectation survey on arrival, which was reviewed by the clinician, 2) the control group completed the expectation survey, which was not reviewed, and 3) the baseline group did not complete an expectation survey. At ED disposition, all groups completed a 3-item satisfaction survey, scored using 5-point Likert scales (1 = very poor, 5 = very good). The primary outcome was rating of "overall care." Secondary outcomes included likelihood of recommending the ED and staff sensitivity to concerns. Proportions were compared by chi-square test.

RESULTS

A total of 304 subjects were enrolled. The proportion of parents rating 5 of 5 for overall care did not differ among the baseline, control, and intervention groups (74.8% vs 73.2% vs 69.2%, P = .56). The proportion of parents rating 5 of 5 also did not differ for likelihood of recommending the ED (77.7% vs 72.2% vs 70.2%, P = .45) or staff sensitivity to concerns (78.6% vs 78.4% vs 78.8%, P = .71).

CONCLUSIONS

For nonurgent pediatric ED visits, clinician knowledge of written parental expectations does not improve parental satisfaction.

Association Between Patient and Emergency Department Operational Characteristics and Patient Satisfaction Scores in a Pediatric Population

BACKGROUND

Emergency departments (EDs) are seeing an increase in the importance of patient satisfaction scores, yet little is known about their association with patient and operational characteristics.

OBJECTIVES

This study aimed to identify patient and operational characteristics associated with patient satisfaction scores.

METHODS

This was a retrospective analysis of data from Press Ganey patient satisfaction surveys of pediatric patients (<18 years) and their families, discharged from the ED of a single, academic, pediatric ED from December 2009 to May 2013. A linear mixed-effects regression model was used to identify significant associations while taking the clustering within patients and physicians into account. Outcome variables included scores for overall experience (0-10), wait time to be seen by a provider (0-100), and likelihood to recommend (0-100). The ED characteristics considered included daily census, proportion of left without being seen, average length of stay (LOS), and total boarding hours, as well as time of day by shift, door-to-room time, and discharge LOS. Patient characteristics included patient age, sex, race, person completing survey, survey language, survey method (mailed or online), payer type, mode of arrival, distance to hospital, weekend or weekday visit, and difference of patient-reported LOS to actual LOS. Only statistically significant variables were included in the final model.

RESULTS

A total of 810 pediatric surveys were included for analysis. The overall mean (SD) was 8.7 (2.0) for overall experience, 84.0 (23.5) for waiting time to be seen by a provider, and 90.1 (22.2) for likelihood to recommend. The score for overall experience was highly correlated with likelihood to recommend (r = 0.90) and less strongly correlated with score for waiting time (r = 0.58). In the final models, increased door-to-room time was associated with a significant decrease in scores for all 3 outcome variables. In addition, a difference between perceived and actual LOS (>2 hours) was significantly associated with lower scores in overall experience and likelihood to recommend, whereas surveys completed online had higher scores for waiting time to see a provider compared with mailed.

CONCLUSIONS

Emergency departments looking to increase satisfaction scores should focus efforts on decreasing door-to-room times.

Parental satisfaction with pediatric emergency care: a nationwide, cross-sectional survey in Korea

PURPOSE

This study attempted to examine parental satisfaction with pediatric emergency care (PEC) in Korea and investigate the features influencing overall satisfaction.

METHODS

A nationwide, cross-sectional survey was conducted among parents who had taken their children to an Emergency Department (ED) in the three years prior to the study. A 21-item, structured questionnaire was administered to the parents through a web-based system. Participants' satisfaction levels and the strength of the association between PEC components and overall satisfaction were rated using a 7-point Likert scale.

RESULTS

In total, 1,000 parents participated in the survey, of which 402 (40.2%) stated that they were generally satisfied with the delivered PEC. Female participants, mothers, and parents with low-acuity patients were more likely to be dissatisfied with the delivered PEC. Although the ED environment was the lowest level of satisfaction, it did not significantly influence the respondents' overall levels of satisfaction. The most influential factors in terms of overall satisfaction were "nurses' professionalism" and "doctors' attitude and proper explanation".

CONCLUSION

Parents' overall level of satisfaction with PEC is relatively low and is closely related to factors associated with ED personnel.

Variables associated with parent satisfaction with their child's pain management

OBJECTIVE

The provision of 'adequate analgesia' (which reduces the pain score by ≥2 and to <4 [0-10 scale]) is significantly associated with high levels of satisfaction with pain management among adult patients. We aimed to determine the variables (including 'adequate analgesia') associated with parent satisfaction with their child's pain management.

METHODS

We undertook an observational, pilot study in a mixed, metropolitan ED. Patients aged 4-16 years with a triage pain score of ≥4 were enrolled. Data included demographics, presenting complaint, pain scores every 30 min, analgesia administered, time to first analgesia, provision of nurse-initiated analgesia (NIA), and 'adequate analgesia', and parent satisfaction 48-h post-discharge (6 point scale: very unsatisfied - very satisfied).

RESULTS

Complete data were collected on 185 patients: mean (SD) age 10.4 (3.6) years, weight 41.9 (17.8) kg; 93 (50.3%) were male. One hundred and ten (59.4%) parents were very satisfied with their child's pain management. Children of very satisfied parents had shorter times to analgesia than those who did not (median [interquartile range] 14 (33) vs 33 (46) min, respectively, P = 0.003). Parents whose children received NIA or 'adequate analgesia' were more often very satisfied than those whose children did not. However, the differences were not significant (difference in proportions: 13.2% [95% CI -1.9, 28.3], P = 0.07 and 10.2% [95% CI -5.02, 25.34], P = 0.16, respectively).

CONCLUSION

Short times to analgesia are associated with parent satisfaction. There were non-significant trends towards high levels of satisfaction following the provision of NIA and 'adequate analgesia'. These findings will inform a well-powered study to confirm this association.

One Size Does Not Fit All: Pediatric Patient Satisfaction Within an Integrated Health Network

It is unknown how differently a factor influences pediatric patient satisfaction across multiple service areas. The objective of the study was to assess relative impacts of factors across 4 health service areas. In this retrospective study of 27 028 responses from patient satisfaction surveys, the multiple-group structural equation modeling was used to assess factor effects. "Physician care" has the largest impact on overall pediatric patient satisfaction in outpatient specialty care with a 1.4-fold, 1.7-fold, and 3-fold reduction in effect in primary care, emergency department, and inpatient care, respectively. "Nursing care" has the largest impact in inpatient care with a 3-fold effect reduction in emergency care. "Personal concern" is an impacting factor in all areas with the largest effect in emergency care. The influence of factors on pediatric patient satisfaction varies significantly across service areas. These findings help health care leaders design customized patient experience models to achieve optimal outcomes across the health system.