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Shallu Chauhan, Deepak AgrawalJPNATC, AIIMS, New Delhi ,India

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Patient satisfaction is an important indicator of the quality of care and service delivery in the emergency department (ED).

To evaluate patient/relative satisfaction level in the ED at JPNATC, AIIMS,New Delhi.

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To determine the effects of actual waiting time, perception of waitingTime and information delivery on patient

satisfaction.

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Prospective Observational study

Study period: 2 months{1st july 2011 to 1st September 2011} during all shifts.

Study Population: Patients who were triaged as green.

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Two groups: Test group

{patient explained for time management & treatment}.

Control group { not explained anything to the patient}.

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Test groupPatient /relatives were told that an injection was required to be administered after 2 hours.

Told to wait for 2 hours for the injection

Placebo (Inj Voveron) given after 2 hours

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DATA COLLECTION:

Month 1: Control Group

Month 2: Test group

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1.Explanation of procedures to the patient.2.Communication of staffs.3.Problems faced by patient/relatives and4. overall patient satisfaction level.

Following next month of first 15 days questionnaire based on a Liker scale concerning waiting time, promptness of staff, cleanliness of hospital and behaviour of staff given to the control group and then for next 15 days same questionnaire given to the test group.

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QUESTIONS BASED ON TIME CONCERN: 1.Overall time management.2.Waiting for X-ray or C.T.scan, dressing/suturing and injections3.Reports review by doctor.4.Time taken for discharge & giving treatment etc.

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MATERIALS AND METHODS Questionnaire Used

TRAUMA BASE LINE PATIENT SATISFACTION OR DISSATISFICATION FORM

Q1. How would you rate overall treatment?

i)Excellent ii)Very good iii)Good iv)Fair v)Poor

Q2.Did you face any problem? If Yes, What?

Q3. How would you rate overall time management?

i)Excellent ii)Very good iii)Good iv)Fair v)Poor

Q4. a)Waiting for X-Ray/CT

i)Excellent ii)Very good iii)Good iv)Fair v)Poor vi)NA

b)Waiting for Doctor review?

i)Excellent ii)Very good iii)Good iv)Fair v)Poor vi)NA

c)Waiting for Discharge/Treatment?

i)Excellent ii)Very good iii)Good iv)Fair v)Poor vi)NA

d)Waiting for Dressing/Suturing?

i)Excellent ii)Very good iii)Good iv)Fair v)Poor vi)NA

Q-5. Did you get injections as per advise of Doctor/Nurse?

a)Yes b)No

Q-6. How would you rate the following?

a)Cleanliness

i)Excellent ii)Very good iii)Good iv)Fair v)Poor

b)Promptness of staff

i)Excellent ii)Very good iii)Good iv)Fair v)Poor

c)Behaviour of Staff

i)Excellent ii)Very good iii)Good iv)Fair v)Poor

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Ninety patients were included in this study. The highest satisfaction rates were observed for cleanliness of hospital in both the groups and most of them rated it as very good.

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Overall treatmentControl Group34% in control group 34% rated as poor & fair67% rated as good and very goodTest group78% rated as very good and excellent.22% rated as poor and fair

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OBSERVATION

Comparing both groups

Both the groups rated as good for overall time management

Time taken by doctor to review

33% rated as fair in control group

22% rated as fair in test goup.

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OBSERVATION

TIME MAXIMUM TIME

MINIMUM TIME

CONTROL GROUP[FOR 30 PATIENTS]

180 MINUTES 30 MINUTES

TEST GROUP[FOR 60 PATIENTS]

120 MINUTES 15 MINUTES

AVERAGE TIME

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OBSERVATION

STAFF BEHAVIOUR

7% rated as an excellent/good in control group

36% rated as an excellent/good in test group.

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OBSERVATION

PROMPTNESS OF STAFF BEHAVIOUR OF STAFF

LIKERT SCALE

CONTROL GROUP

TEST GROUP

POOR 10% 8%

FAIR 23% 23% 23% 15% GOOD

VERY GOOD 37% 18% 7% 36% EXCELENT

LIKERT SCALE

CONTROL GROUP

TEST GROUP

POOR 17% 0%

FAIR 30% 22% 27% 28% GOOD

VERY GOOD 23% 30% 3% 20% EXCELENT

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BRIEF OVERVIEWTest Group (n=60) Control Group(n=30) P value*

Median (Min., Max.) Median (Min., Max.)Overall Treatment 4(1-5) 3(1-5) 0.033Overall Time Management

3(1-5) 3(1-5) 0.149

Waiting for X-ray or CT 4(2-5) (n=58) 3(1-5) (n=28) 0.012Waiting for Dr. reviews

3(1-5) 2(1-5) 0.016Waiting for Discharge or Treatment

3(1-5) 3(1-5) 0.623

Waiting for Dressing or Suturing

3(1-5) 2.5(1-5) 0.002

Cleanliness 4(2-5) 4(2-5) 0.416Promptness of Staff 3.5(1-5) 2(1-5) 0.002Behavior of Staff 4(1-5) 3(1-5) 0.121

* Mann-Whitney Test

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RESULTS

Actual waiting time were not predictive of overall patient satisfaction.

Relatives/ patients who were explained about the need for waiting and given plcebo had significantly better satisfaction levels

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*Providing information, managing time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the ED than decreasing actual waiting time.

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CONCLUSIONSThe study findings indicated the need for evidence-based interventions in emergency care services in areas such as medical or nursing care, courtesy of staff, comfort of the patient and waiting time.

Efforts should focus on shortening waiting intervals and improving patients' perceptions about waiting in the ED.

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