Parental satisfaction with paediatric care, triage and waiting times

Instruments to evaluate hospitalised children parents' satisfaction with nursing care: a scoping review

AIM

To identify instruments that allow the evaluation of parent's satisfaction regarding nursing care during their child hospitalisation.

METHODS

A review was performed using Preferred Reporting Items for Scoping Reviews. The study was prospectively registered in Open Science Framework. Research was carried out on EBSCOhost, PubMed, SciELO, Web of Science and ScienceDirect platforms as well as grey literature. Additionally, the references of selected articles were also examined.

RESULTS

A sample of 65 articles allowed the identifications of 38 distinctive instruments to evaluate parents' satisfaction in different hospital settings. Most studies were applied in paediatric wards (n=28), followed by neonatal intensive care units (n=21), paediatric intensive care units (n=9) and emergency departments (n=7). Sample size ranged from 13 to 3354 and 3 studies used mixed methods, 20 were methodological studies of instruments construction or validation and 43 were quantitative studies. 21 different instruments previously existent were found. In 3 studies, adapted instruments were used and, in 14 studies, structured instruments were purposively designed for the study. Instruments had between 1 and 13 domains and total number of items ranged between 13 and 92. Most studies assessed overall satisfaction (n=53) and instrument reliability (n=49) and/or validity (n=37).

CONCLUSION

Most instruments consider nursing care as a domain of satisfaction. Only two instruments focused specifically on nursing care. In most of the studies, there was a concern to evaluate instruments psychometric properties. This review clearly shows that there is still a gap in the literature on the range of aspects that influence satisfaction and a lack of consensus on ideal conditions for instrument use and application.

Parental Satisfaction and Associated Factors Toward Their Child's Anesthesia Service at a Comprehensive Specialized Referral Hospital in Ethiopia, 2021: A Cross-Sectional Study

BACKGROUND

Parental satisfaction is a key measure of the quality of a child's anesthetic care. Understanding of parents' opinions and satisfaction about their child's anesthesia service in the hospital is vital for hospital funding and parent experience.

OBJECTIVE

The purpose of this study was to determine the level of parental satisfaction with their child's anesthetic care and the factors that contributed to that satisfaction.

METHODS

An institution-based cross-sectional study was undertaken between March and June 2021. A structured questionnaire with the background characteristics of parents and children was used to collect data. A total of 238 parents were included in the study. To find parameters linked to parental satisfaction with their child's anesthetic service, bi-variable, and multi-variable logistic regression analyses were used. Crude odds ratio and adjusted odds ratio with a 95% confidence interval (CI) were estimated. Variables with a p-value < 0.05 were considered statistically significant in multivariable analysis.

RESULT

The proportion of parental satisfaction toward their child's anesthesia service was 77.7% (95% CI: 72.3, 82.4%). Non-anxious, male, employed, and urban resident parents and parents of pre-medicated children were associated with high satisfaction scores.

CONCLUSION AND RECOMMENDATION

Overall, parents' satisfaction with their child's anesthesia service was promising. Parents who were non-anxious, male, employed, and lived in an urban area and whose child had received sedative premedication had high rates of parental satisfaction with their child's anesthetic care.Parents from rural areas, as well as worried and female parents, should receive extra care. Preoperative anxiety is reduced when parents are given enough and understandable information. Thus, the provision of comprehensive information on their child's anesthesia care process and psychological or emotional support to parents are necessary to boost their satisfaction.

Translation, adaptation and testing of an emergency care satisfaction scale in Swedish pediatric emergency departments

BACKGROUND

Pediatric healthcare today shows a rising demand for research focusing on children's perspectives on and consumer satisfaction with the nursing care they receive. Therefore, the purpose of this study was to translate and adapt the Consumer Emergency Care Satisfaction Scale (CECSS), a paper-based, self-administered 19-item questionnaire originally developed in the United States and targeted towards adults, and then test the new version in Swedish pediatric emergency departments.

METHODS

The study was designed with a two-phase approach. Firstly, a forward-backward translation of the CECSS, involving expert consensus, was performed, and then the questionnaire was adapted for children aged 10-18 and assessed for face and content validity. Secondly, the translated and adapted questionnaire was tested with a clinical sample for construct validity, internal consistency, and reliability. This last aspect was assessed using a structured telephone interview 7-10 days after the participant visited a pediatric emergency department. All children participating in this study gave their assent (< 15 years) or consent (≥ 15 years), and their guardian's written informed consent was also obtained.

RESULTS

The paper-based, self-administered 19-item Swedish version of the CECSS was tested on a clinical sample consisting of 203 nonurgent children (boys: n = 109, 53.7 % and girls: n = 94, 46.3 %) between 10 and 18 years (mean age 13.8, SD 2.29). The factor analysis revealed three factors that explain 63.1 % of the total variation in the 15 items. The Cronbach's alphas for the three dimensions (caring, teaching, and clinical competence) varied between 0.79 and 0.88. The intraclass correlation coefficient (ICC) for the entire Swedish version of the CECSS was 0.58, and the ICCs for the three dimensions varied between 0.56 and 0.71.

CONCLUSIONS

The results show that the developed Swedish Pediatric Consumer Emergency Care Satisfaction Scale (p-CECSS-S) is a valid, stable and easy-to-use-questionnaire that can be used to assess children's satisfaction with nursing care.

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.

Parents' and carers' impression of "quality" within a Paediatric Emergency Department

Background

Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback.

Methods

A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”.

Results

One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%).

Conclusion

We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02752-7.

Parental satisfaction with waiting time in a Swiss tertiary paediatric emergency department

INTRODUCTION

Patient numbers in paediatric emergency departments (PED) are steadily increasing. Parental perception of waiting time and reasons for attending a PED with non-emergencies have been investigated in the UK, Australia, Korea, Canada and the USA. We sought to examine which factors influence parental satisfaction with waiting time in a tertiary Swiss PED and whether these differed from other countries.

METHODS

Paper surveys were administered to parents of children presenting to our interdisciplinary PED from February to May 2015. Primary outcome was parental satisfaction with waiting time, secondary outcomes were satisfaction with treatment, parental reasons for presentation with non-emergencies, parental perception of times to triage, first physician contact and disposition from ED, level of physician training, understanding of various anticrowding strategies and comparison of perceived and true waiting times to triage and physician contact.

RESULTS

739 out of 750 surveys were returned (57 complete, 298 with 1 or 2 missing answers). Satisfaction with waiting time (on a 5-point-Likert-scale; 1 being the best possible answer) was higher in groups with shorter waiting time until triage (+0.41, p=0.001), first physician contact (+1.43, p<0.001) and discharge (+0.71, p<0.001), higher triage category urgency (+0.47, p=0.044) and available entertainment (+0.82, p<0.001). Early first physician contact (+0.33, p=0.008) and time to discharge less than 4 hours (+0.37, p<0.001) was associated with greater satisfaction with treatment (p<0.05). The most frequent reasons for presentation were parental impression that the child had an emergency (n=265, 35.9%) and referral by the family doctor (n=245, 33.2%).

CONCLUSION

To counteract parental dissatisfaction associated with waiting time, we suggest the implementation of feasible measures including entertainment while waiting, early first medical review and timely discharge from the PED.

Patient Reported Experience in a Pediatric Emergency Department

Objectives:

To describe patient-reported experience in a pediatric emergency department (ED) and determine: (1) whether there are differences between the experience children report in comparison to their parents; and (2) whether factors such as time of visit (day, evening, night) and ED census are associated with patient experience.

Methods:

We conducted a prospective cross-sectional survey of children ≥8 years of age and the parents/guardians of children 0 to 17 years who visited a pediatric ED using a validated patient experience measure. The proportion of respondents for each question indicating that an aspect of their care could have been improved was calculated as problem scores for each survey item. The primary outcome was the overall problem scores for all respondents combined and for children and parents separately.

Results:

A total of 237 parents and 109 children completed surveys. The areas with the highest problem scores identified by both parents and children were: having enough to do while waiting to be seen (53.5; 95% confidence interval [CI]: 48.1, 58.8) and when to restart usual activities (34.7; 95% CI: 29.7, 40.0). There were meaningful differences in problem scores between children and parents including: doctors and nurses explaining what they were doing (parents: 19; 95% CI: 14.3, 24.7, child 40.4; 95% CI: 31.2, 50.2) and privacy when examined and treated (parents: 17.3; 95% CI: 12.8, 22.9, child: 36.7; 95% CI: 27.8, 46.5).

Conclusion:

There are differences in reported experience between children and their parents. This highlights the importance of including children when assessing patient experience in a pediatric setting.

A Measurement Scale to Assess Children's Satisfaction with Hospitalization in the Andalusian Population

Background: Patient satisfaction is a principal indicator in the evaluation of the stay of pediatric patients in hospitals, since its consequences can emotionally interfere with health treatment. The aim of this study was to obtain a valid scale to assess children’s satisfaction with their time spent as a patient in an Andalusian hospital. Method: The Children’s Satisfaction with Hospitalization Questionnaire (CSHQ) was applied to 623 pediatric patients hospitalized in Andalusia. An exploratory factor analysis (EFA) showed one dimension underlying the children’s satisfaction with their hospitalization. After that, we developed a depuration analysis process to achieve a valid and unidimensional scale to assess children’s satisfaction. Results: The eleven-item one-dimension solution showed suitable consistency and goodness-of-fit indices. The final scale addresses hosting aspects as the main dimension of a minor’s satisfaction in Andalusian hospitals. Conclusion: A unidimensional scale has been determined for the assessment of children’s satisfaction with their stay in Andalusian hospitals based on hosting aspects. Nonetheless, other dimensions underlying the satisfaction of patients should also be considered.

Family members’ satisfaction with the care flow in the Pediatric Emergency Department

ABSTRACT Objective: To evaluate the satisfaction index of the pediatric patient’s caregiver (person responsible for the child) regarding the waiting time for the care flow in an emergency service. Method: A prospective, cross-sectional, quantitative study with 300 family members in the Pediatric Emergency Department of a general hospital. An instrument was used to analyze the service flow, waiting time and satisfaction evaluation. Descriptive statistical analysis was performed. Results: The satisfaction index of caregivers was statistically significant (p<0.05) the lower was the waiting time for patient screening, care by the doctors and for receiving the prescribed medication. Caregivers who took their children to the emergency department because of the disease (p -0.029) or because they did not find doctors in other hospitals (p-0.021) were satisfied with the waiting time for this service. Conclusion: The quality of care is evaluated as satisfactory by caregivers when children are treated quickly in the Pediatric Emergency Department.

Parent's Experiences of Their Children Suffering Febrile Seizures

PURPOSE

To explore parents' experiences of their child suffering febrile seizures.

DESIGN AND METHOD

Seven mothers and four fathers with experience of one or several febrile seizures in their children were interviewed. A qualitative content analysis with an inductive approach was performed.

RESULT

Five themes emerged; emotional experiences, in terms of anxiety and fear, and need for control, need for support, need for acknowledgement and need for comfort. Professional assurance and support from healthcare staff was considered important to help parents handle the situation.

CONCLUSION

Febrile seizure caused anxiety due to parents' lack of comprehension about the event and how to act during the seizure.

PRACTICE IMPLICATIONS

The pediatric nurse plays an important role in gaining the trust of and supporting parents whose children have suffered febrile seizures. They can alleviate concerns that arise, and also generate assured and well informed parents, who are better prepared to deal with recurrent febrile seizures.

[Development and pilot study of a questionnaire to assess child and teenager satisfaction with their stay in hospital]

OBJECTIVE

To develop an instrument to assess the satisfaction of children and teenagers with their stay in hospital.

METHODS

A qualitative analysis of hospitalisation satisfaction dimensions based on the feedback of hospitalised children and teenagers; a content validation study by a group of experts of the items generated for the different satisfaction dimensions; and a pilot study to assess the usefulness of the questionnaire with a sample of 84 children and teenagers hospitalised in Andalusia.

RESULTS

After successive refinements, a short questionnaire was obtained which took between 5 and 15minutes to complete. All items presented positive item-total correlations (r>0.18). The questionnaire showed an internal consistency index of 0.779 (Cronbach's alpha) and significant rank differences (Mann-Whitney U test; p<0.001) with medium size effects (η²>0.151) in three satisfaction dimensions compared between hospitals.

DISCUSSION

A short, easy-to-answer questionnaire was developed that is reliable regarding its internal consistency and sensitive to differences in hospital satisfaction dimensions. Once validated, it will be used to assess the satisfaction of children and teenagers with their hospital stay, in addition to being a potential indicator of quality of care.