Is the right to information fulfilled in an emergency department? Patients' perceptions of the care provided

The Association Between Wait Times and Patient Satisfaction: Findings From Primary Health Centers in the Kingdom of Saudi Arabia

Background:

It is no doubt that longer wait times can affect patient care and patients’ willingness to seek health-care services. Not only does this disrupt the continuity of treatment and care, but it also negatively impacts patient outcomes. During the past few years, the concept of patient satisfaction has become a vital component in assessing the delivery and efficiency of care. Patient satisfaction is a performance indicator that measures the extent to which patient is content and satisfied with the level of care provided by health-care institutions and providers. Therefore, this research examined association between the wait times and patient satisfaction in selected primary health-care centers in Al Qassim region in the Kingdom of Saudi Arabia.

Methodology:

A patient satisfaction questionnaire was administered to 850 patients, which collected patient perceptions on the delivery of care at health-care centers in Al Qassim City. Outcome measures included wait times for: registration and payment, seeing the physician, performing radiation and assays, and dispensing the medications.

Results:

The response rate was 72.94% (n = 620). The study found that 27.90% of the participants stated that the wait time to see the physician ranged between 21 and 30 minutes. Overall patients were mainly dissatisfied for wait times in relation to medication dispensation, vital signs measurement, dental consultations, and radiological investigation. The study found a positive association between the patient satisfaction and their education, marital status, and job. A significant regression equation was established between the patient satisfaction and age-group and literacy.

Conclusion:

The study advocated the need for recent technology, sufficient staffing, and patient-centered friendly methods to reduce wait times.

Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction

OBJECTIVES

First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients' immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions.

MATERIALS AND METHODS

Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73).

RESULTS

Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions.

DISCUSSION

Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions.

CONCLUSION

It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients' short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients' understanding of and interaction with their discharge instructions is improved by the addition of illustrations.

Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit: a prospective comparative study

AIMS AND OBJECTIVES

To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit.

BACKGROUND

An increase in emergency department observation units has led to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses.

DESIGN

A comparative field study.

METHODS

The study included 21 patients. Participant observation and qualitative interviews were performed, and the analyses were phenomenological-hermeneutic.

RESULTS

Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating distrust. Emergency department observation unit patients had more encounters with fellow patients than the surgical assessment unit patients did, which was beneficial when needing assistance, but disturbing when needing rest. The limited contact with other patients in the surgical assessment unit revealed the opposite effect. In both units, there was nonpersonalised care, making it difficult for patients to make informed decisions.

CONCLUSION

The multibedded rooms in the emergency department observation unit had a positive influence on patient–nurse interaction, but a negative influence on privacy; the opposite was found in the surgical assessment unit with its rooms with fewer beds. The extensive professional–patient interactions in the emergency department observation unit created distrust. The limited professional–patient interaction in the surgical assessment unit did the same. That the emergency department observation unit was staffed by emergency nurses seemed to have a positive influence on the length of patient–nurse interactions, while the surgical assessment unit staffed by specialist nurses seemed to have the opposite effect. There was lack of information and personalised care in both units.

RELEVANCE TO CLINICAL PRACTICE

Units receiving acute patients need to provide personalised care and information about how the unit functions and about care and treatment to improve the patients' ability to make decisions during admission.

Adherence to medication: A nation-wide study from the Children’s Cancer Hospital, Egypt

AIM: To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt.

METHODS: We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children’s Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read the questions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child’s medical journal. The study period consisted of 7 mo (February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher’s exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, United States).

RESULTS: Two hundred and eighty-one (90%) parents answered the second questionnaire, regarding their child’s adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment (181/281, 64%). Sixty-eight percent (123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance (111/123, 90%) and inadequate information (100/123, 81%). In the adherent group, 20% of the parents (n = 12/58) reported trust in their child’s doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123 (7%) for both their child’s doctor and other health-care professionals. Almost all of the parents expressed a lack of optimism towards the treatment (116/121, 96%), yet they reported an intention to continue with the treatment for two main reasons, for the sake of their child’s life (70%) (P = 0.005) and worry that their child would die if they discontinued the treatment (81%) (P < 0.0001).

CONCLUSION: Non-adherence to medical regimen is common among children diagnosed with cancer in Egypt, the main reasons being child resistance and inadequate information.