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Emergency Medicine Australasia (2014) 26, 177–182
doi: 10.1111/1742-6723.12202
PAEDIATRIC EMERGENCY MEDICINE
Parental satisfaction with paediatric care, triage and waiting times Nicholas FITZPATRICK,1 Daniel T BREEN,2,3 James TAYLOR,1 Eldho PAUL,4 Robert GROSVENOR,5 Katrina HEGGIE1 and Patrick D MAHAR6 1 Emergency Department, Sandringham Hospital, Alfred Health, Melbourne, Victoria, Australia, 2Department of Surgery, The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia, 3Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia, 4Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia, 5Melbourne Business School, The University of Melbourne, Melbourne, Victoria, Australia, and 6Department of Medicine, St Vincent’s Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
Abstract Objective: The present study aims to determine parental and guardian’s perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. Methods: A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. Results: One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate
than urgent, less-urgent or non-urgent patients. Conclusion: On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients’ expectations and perceptions. Key words: management, paediatric, patient satisfaction, triage, waiting time.
Background An understanding of parental perceptions of healthcare with respect to the assessment and treatment of their children has numerous benefits for health professionals, parents and our paediatric patients. Greater comprehension of where parents place importance during the journey through an ED has the potential to increase treatment
Correspondence: Dr Patrick D Mahar, Department of Medicine, St Vincent’s Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia. Email: [email protected] Nicholas Fitzpatrick, MBBS, PGDipSurgAnat, Hospital Medical Officer; Daniel T Breen, MBBS, PGDipSurgAnat, Surgical Registrar; James Taylor, MBBS, FACEM, Director; Eldho Paul, MSc, Biostatistician; Robert Grosvenor, BE (Hons), MBA Candidate; Katrina Heggie, MBBS (Hons), BBMedSci, Hospital Medical Officer; Patrick D Mahar, MBBS (Hons), LLB (Hons), MBA, Clinical Fellow. Accepted 19 December 2013
Key findings • Parental perceptions of care may have significant benefits to health professionals, parents and paediatric patients; particularly in stressful environments such as the ED waiting room. • We found that parental perceptions and overall satisfaction of care does not appear to be influenced primarily by the time spend waiting or receiving treatment in our ED. • Parents of patients who are triaged as ‘semi-urgent’ may have a less positive experience than those who are triaged as ‘urgent’ or ‘non-urgent’, despite waiting similar average times as ‘nonurgent’ patients.
compliance, minimise complications and reduce subsequent visits to other health practitioners. A number of commentators in Australia have described the utility of patient complaints as an opportunity for delivering insight and education with respect to improving work environments and patient satisfaction.1,2 The decision of patients to complain and litigate has been associated with a perceived lack of caring and/or collaboration in health provision, often as a result of discounting patient or family concerns, poor delivery of information and lack of understanding of patient or family perspectives. 3–6 This is especially
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
178
TABLE 1.
N FITZPATRICK ET AL.
Australasian triage system guidelines and sample sizes
Triage category
Category 1 Category 2 Category 3 Category 4 Category 5
Acuity
Recommended time to be seen by a doctor
Emergent/resuscitation (immediately life-threatening) Immediate (imminently life-threatening) Urgent (potentially life-threatening or important time critical treatment or severe pain) Semi-urgent (potentially life-serious or situational urgency or significant complexity) Non-urgent/less urgent
Immediate
relevant in an era where patient experiences and complaints can be easily and widely accessed through social media and doctor-rating websites. By recognising and addressing these nonclinical but vital areas, health professionals working with a paediatric population ensure a more holistic approach and thereby improve overall patient care. Multiple studies have been undertaken over recent decades to evaluate patients’ expectations and perception of waiting times, satisfaction with care and perceptions of care by emergency staff in adult populations.7–9 Community EDs are designed to serve geographical areas and treat both adult and paediatric populations. As such, ED staff must adapt a clinical approach suitable to both populations. In a paediatric context, research evaluating parental perceptions of patient care tends to be focused on non-Australian paediatric-specific institutes.10,11 Parental perceptions of emergency patient care in community hospitals not designed exclusively for paediatric care is not well established in Australia. In the absence of empirical data obtained from parents or carers of paediatric patients, it is hard to know the prevalence and degree of dissatisfaction with EDs. Although emergency care should be delivered at the same standard to all members of the public in order to ensure equity, it is important to understand segments of a population who might be more likely to be dissatisfied with care. In this manner, additional reassurance can be provided with respect to appropriate standards of care and explanations provided as to
Sample size of completed questionnaires n (%) 0 (0)
10 min 30 min
2 (1.5) 34 (25.6)
60 min
86 (64.7)
120 min
11 (8.3)
appropriate expectations in order to decrease dissatisfaction in these groups. The present study ultimately aims to identify how parents and guardians who have presented to a community ED perceive the care provided to paediatric patients. This might suggest aspects of care that could be improved in a community emergency setting not designed exclusively for paediatric patients.
Methodology Setting Sandringham Hospital in Melbourne, Victoria, is a metropolitan community hospital associated with the Alfred Health network. The ED is a 24 h 7 days per week service that sees over 30 000 emergency presentations per year. Approximately 30% of emergency presentations to Sandringham Hospital are paediatric patients.
Ethics The present study was approved by the Alfred Health Research and Ethics Department before commencement of data collection.
Survey development Following a review of published literature and peer review involving an emergency physician, a paediatrician, junior medical staff and emergency nursing staff, two pilot questionnaires were developed with the aim of assessing parental perceptions of paediatric care in an emergency environment.
Each survey format was comprised of relevant demographic information and a number of responses assessed using a 5-point Likert scale. Two versions of the questionnaire were created to undertake internal consistency and intermethod reliability testing. Version one consisted of a symmetrical 5-point scale, and version two consisted of a skewed (non-symmetrical) scale. Both versions contained basic demographic data collected including the participant’s relationship to the child, the number of children within the family, the reason for attending the ED as well as referral source and the general health of the child. After obtaining verbal consent from participants, both versions were tested on 25 parents over 25 different emergency presentations. Cronbach’s alpha coefficient was calculated for each survey format to determine internal consistency. Following further peer review of face validity and removal of internally inconsistent questions, the positively framed symmetrical scale (version one) was determined to be the best performing questionnaire and was used for the remainder of the study. Triage categories used were derived from the Australasian Triage System guidelines, described in Table 1.12 Intermethod reliability testing was then undertaken on the final questionnaire and observed agreement and weighted Kappa values were obtained.
Study population and data collection All parents or guardians over the age of 18 who presented to Sandringham Emergency Department over the period
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
179
PAEDIATRIC EMERGENCY WAITING AND TRIAGE TIMES
TABLE 2. Triage category
Triage categories, average waiting and treatments and overall satisfaction score Respondents
Age (years)
Mother : Father : Guardian (%)
Wait time (min)
Treatment time (min)
Perception of wait†
Overall satisfaction score‡
0 2 34 86 11
n/a 4.42 6.37 7.43 9.84
n/a 50 : 50 : 0 59 : 38 : 3 68 : 28 : 4 78 : 22 : 0
n/a 7.0 31.7 42.5 42.5
n/a 200 105.9 51.3 33.9
n/a 100 81 67 100
n/a 100 88 82 100
1 2 3 4 5
†Percentage of respondents answering ‘agree’ or ‘strongly agree’ to ‘Waiting time was appropriate for the severity of illness’. ‡Percentage of respondents answering ‘agree’ or ‘strongly agree’ to ‘Overall I was satisfied with care’.
October 2011 to February 2012, who accompanied a paediatric patient (defined as any patient aged
Emergency Medicine Australasia (2014) 26, 177–182
doi: 10.1111/1742-6723.12202
PAEDIATRIC EMERGENCY MEDICINE
Parental satisfaction with paediatric care, triage and waiting times Nicholas FITZPATRICK,1 Daniel T BREEN,2,3 James TAYLOR,1 Eldho PAUL,4 Robert GROSVENOR,5 Katrina HEGGIE1 and Patrick D MAHAR6 1 Emergency Department, Sandringham Hospital, Alfred Health, Melbourne, Victoria, Australia, 2Department of Surgery, The Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia, 3Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia, 4Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia, 5Melbourne Business School, The University of Melbourne, Melbourne, Victoria, Australia, and 6Department of Medicine, St Vincent’s Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
Abstract Objective: The present study aims to determine parental and guardian’s perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. Methods: A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. Results: One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate
than urgent, less-urgent or non-urgent patients. Conclusion: On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients’ expectations and perceptions. Key words: management, paediatric, patient satisfaction, triage, waiting time.
Background An understanding of parental perceptions of healthcare with respect to the assessment and treatment of their children has numerous benefits for health professionals, parents and our paediatric patients. Greater comprehension of where parents place importance during the journey through an ED has the potential to increase treatment
Correspondence: Dr Patrick D Mahar, Department of Medicine, St Vincent’s Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia. Email: [email protected] Nicholas Fitzpatrick, MBBS, PGDipSurgAnat, Hospital Medical Officer; Daniel T Breen, MBBS, PGDipSurgAnat, Surgical Registrar; James Taylor, MBBS, FACEM, Director; Eldho Paul, MSc, Biostatistician; Robert Grosvenor, BE (Hons), MBA Candidate; Katrina Heggie, MBBS (Hons), BBMedSci, Hospital Medical Officer; Patrick D Mahar, MBBS (Hons), LLB (Hons), MBA, Clinical Fellow. Accepted 19 December 2013
Key findings • Parental perceptions of care may have significant benefits to health professionals, parents and paediatric patients; particularly in stressful environments such as the ED waiting room. • We found that parental perceptions and overall satisfaction of care does not appear to be influenced primarily by the time spend waiting or receiving treatment in our ED. • Parents of patients who are triaged as ‘semi-urgent’ may have a less positive experience than those who are triaged as ‘urgent’ or ‘non-urgent’, despite waiting similar average times as ‘nonurgent’ patients.
compliance, minimise complications and reduce subsequent visits to other health practitioners. A number of commentators in Australia have described the utility of patient complaints as an opportunity for delivering insight and education with respect to improving work environments and patient satisfaction.1,2 The decision of patients to complain and litigate has been associated with a perceived lack of caring and/or collaboration in health provision, often as a result of discounting patient or family concerns, poor delivery of information and lack of understanding of patient or family perspectives. 3–6 This is especially
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
178
TABLE 1.
N FITZPATRICK ET AL.
Australasian triage system guidelines and sample sizes
Triage category
Category 1 Category 2 Category 3 Category 4 Category 5
Acuity
Recommended time to be seen by a doctor
Emergent/resuscitation (immediately life-threatening) Immediate (imminently life-threatening) Urgent (potentially life-threatening or important time critical treatment or severe pain) Semi-urgent (potentially life-serious or situational urgency or significant complexity) Non-urgent/less urgent
Immediate
relevant in an era where patient experiences and complaints can be easily and widely accessed through social media and doctor-rating websites. By recognising and addressing these nonclinical but vital areas, health professionals working with a paediatric population ensure a more holistic approach and thereby improve overall patient care. Multiple studies have been undertaken over recent decades to evaluate patients’ expectations and perception of waiting times, satisfaction with care and perceptions of care by emergency staff in adult populations.7–9 Community EDs are designed to serve geographical areas and treat both adult and paediatric populations. As such, ED staff must adapt a clinical approach suitable to both populations. In a paediatric context, research evaluating parental perceptions of patient care tends to be focused on non-Australian paediatric-specific institutes.10,11 Parental perceptions of emergency patient care in community hospitals not designed exclusively for paediatric care is not well established in Australia. In the absence of empirical data obtained from parents or carers of paediatric patients, it is hard to know the prevalence and degree of dissatisfaction with EDs. Although emergency care should be delivered at the same standard to all members of the public in order to ensure equity, it is important to understand segments of a population who might be more likely to be dissatisfied with care. In this manner, additional reassurance can be provided with respect to appropriate standards of care and explanations provided as to
Sample size of completed questionnaires n (%) 0 (0)
10 min 30 min
2 (1.5) 34 (25.6)
60 min
86 (64.7)
120 min
11 (8.3)
appropriate expectations in order to decrease dissatisfaction in these groups. The present study ultimately aims to identify how parents and guardians who have presented to a community ED perceive the care provided to paediatric patients. This might suggest aspects of care that could be improved in a community emergency setting not designed exclusively for paediatric patients.
Methodology Setting Sandringham Hospital in Melbourne, Victoria, is a metropolitan community hospital associated with the Alfred Health network. The ED is a 24 h 7 days per week service that sees over 30 000 emergency presentations per year. Approximately 30% of emergency presentations to Sandringham Hospital are paediatric patients.
Ethics The present study was approved by the Alfred Health Research and Ethics Department before commencement of data collection.
Survey development Following a review of published literature and peer review involving an emergency physician, a paediatrician, junior medical staff and emergency nursing staff, two pilot questionnaires were developed with the aim of assessing parental perceptions of paediatric care in an emergency environment.
Each survey format was comprised of relevant demographic information and a number of responses assessed using a 5-point Likert scale. Two versions of the questionnaire were created to undertake internal consistency and intermethod reliability testing. Version one consisted of a symmetrical 5-point scale, and version two consisted of a skewed (non-symmetrical) scale. Both versions contained basic demographic data collected including the participant’s relationship to the child, the number of children within the family, the reason for attending the ED as well as referral source and the general health of the child. After obtaining verbal consent from participants, both versions were tested on 25 parents over 25 different emergency presentations. Cronbach’s alpha coefficient was calculated for each survey format to determine internal consistency. Following further peer review of face validity and removal of internally inconsistent questions, the positively framed symmetrical scale (version one) was determined to be the best performing questionnaire and was used for the remainder of the study. Triage categories used were derived from the Australasian Triage System guidelines, described in Table 1.12 Intermethod reliability testing was then undertaken on the final questionnaire and observed agreement and weighted Kappa values were obtained.
Study population and data collection All parents or guardians over the age of 18 who presented to Sandringham Emergency Department over the period
© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
179
PAEDIATRIC EMERGENCY WAITING AND TRIAGE TIMES
TABLE 2. Triage category
Triage categories, average waiting and treatments and overall satisfaction score Respondents
Age (years)
Mother : Father : Guardian (%)
Wait time (min)
Treatment time (min)
Perception of wait†
Overall satisfaction score‡
0 2 34 86 11
n/a 4.42 6.37 7.43 9.84
n/a 50 : 50 : 0 59 : 38 : 3 68 : 28 : 4 78 : 22 : 0
n/a 7.0 31.7 42.5 42.5
n/a 200 105.9 51.3 33.9
n/a 100 81 67 100
n/a 100 88 82 100
1 2 3 4 5
†Percentage of respondents answering ‘agree’ or ‘strongly agree’ to ‘Waiting time was appropriate for the severity of illness’. ‡Percentage of respondents answering ‘agree’ or ‘strongly agree’ to ‘Overall I was satisfied with care’.
October 2011 to February 2012, who accompanied a paediatric patient (defined as any patient aged
