Patient Satisfaction Analysis in Emergency Department in Imam Reza Hospital of Mashhad

The mean waiting time of patients was 10.7 ± 6.1 minutes with a maximum of 44 minutes and minimum of two minutes. The average score of total patients satisfaction from sum of 3 aspects of questionnaire was 59.07±11.46 and the mean score of satisfaction during attendance in ED, during physician's visit and overall satisfaction was 25.24±5.04 (min: 9, max: 41), 25.32±5.42 (min: 9, max: 45), 8.52±1.91 (min: 3, max: 15) respectively. Frequency distribution of responses to questionnaire divided into 3 sections (satisfaction of attendance in ED, of physician's visit and overall satisfaction) were shown in table 2.

There was a small statistically significant reverse correlation between waiting time and satisfaction rate during attendance in ED (r=-0.15, p=0.003), during physician's visit (r=-0.12, p=0.01), overall performance of emergency (r=-0.1, p=0.04) and totally satisfaction score (r=-0.14, p=0.003). In addition, there was a small positive correlation between the age of patients and satisfaction score of attendance in ED (r=0.1, p=0.04), but there was not any correlation between satisfaction score of physician's visit and overall performance with age of participants (p=0.12, p=0.47).

To predict concerning factors related to higher satisfaction linear regression by forward method applied. Age and disposition (p=0.04, p=0.001) were identified as predictors of satisfaction during attendance in ED. disposition, sex and waiting time (p=0.02, p=0.02, p=0.03) were predictors of satisfaction during physician's visit and merely disposition (p=0.002) was the predictors of overall satisfaction rate (Table 3).

 Discussion

Patient satisfaction is one of the most important indicators of emergency care quality that delivered by staff of emergency department and outcomes of health care services (2[a1] ). Assessment of health care quality and improving patient’s satisfaction has become increasingly prevalent particularly among health care providers and purchasers of health care system (5).

The findings showed that patient satisfaction scores during attendance in ED, during physician's visit and during overall assessment were in the average level was similar to Zohrevandi's research and it suggests many unmet needs (2). The highest satisfaction of patients was from speed of admission, courtesy of the physician and nursing skills for performing medical orders, respectively. The lowest satisfaction was from comfort and pleasantness of the waiting area, amount of time spent with doctors and length of waiting time before physicians visit, respectively. As the study by Zohrevandi shows that total score of five assessed sections related to Patients comfort and residential aspects, physicians care, nurse care, behavioral aspects and waiting time for services are on average level but the nurse care aspects have the best level among five sections and waiting for services and behavioral aspects gained the maximum dissatisfaction (2). Also in Soleimanpour's study, the highest satisfaction was from physicians' courtesy and behavior with the patients, security guard's courtesy and nurse's courtesy with patients, the lowest level of satisfaction refers to the care provider's efforts to get the patients involved in making decisions about their own treatment, waiting time for the first visit and cleanliness and neatness (3).

A significant correlation was seen between satisfaction scores of attendance in ED and age of patients, this may be because of low level of expectations and reasonable attitude of elder people.

Similar to Davis's study that reported a significant relationship between age of patients and their satisfaction (7) but Hall's and Press study shows that age of patients doesn't have a profound impact on satisfaction scores (8).

There was significant association between gender and mean score of satisfaction and was higher in females that probably because the higher level of tolerance in women. Mckinley's [a2] study have mentioned that satisfaction rate was different among individuals with various social class, age and gender (9), similar to Hargrave's study (10).

Also in San's study satisfaction score of women was higher than men because of the more patience of women than men (11). On the other hand most of caring personnel and nurses were female and might make better communication with female patients and better understanding of their pains and problems lead to more satisfaction among female patients. However in Soleimanpour's, Hall's, Aragon's and alexius's studies there was no statistically significant difference between gender and satisfaction (2, 8, 12, 13). A systematic review by Taylor's found that patients age and race influenced satisfaction in some but not all studies (14).

However in this report, there was not statistically significant association between place of residence and satisfaction score but urban residents somewhat have higher satisfaction rate, probably due to the problems of remoteness and lack of facilities and accommodation for the rural residents. In Soufi's study, urban residents have mentioned more satisfaction too (5).

There was no significant relationship between work shifts, educational level, type of admission and satisfaction level similar to Soleimanpour's and Soufi's studies (3,5), but in Damghi's study patients with a lower educational level were less satisfied, may be high educational persons more likely to accept that rescue was dependent on good management despite uncomfortable situations(4).

However in our report there was no significant reverse association between educational level and satisfaction probably due to low level of expectation and lack of knowledge about their rights among them.

Despite our findings, in some studies like Zohrevandi and Press Ganey reports (2,15), the highest satisfaction of emergency department was in morning admission shift may be because the morning shift is the most crowded work shift and thus the waiting time is shorter than in the night shift. In Soufi's study also there was an association between patient satisfaction and type of admission (5). Consistent with other studies, our findings also indicated that there is a reverse correlation between patient satisfaction and waiting time. Those who waited longer were less satisfied. Zohrevand's, Damghi's, Press Ganey and Topacoglu's studies all reported a direct association between waiting time and patient dissatisfaction (2, 4, 15, 16, 17).

There are some limitations in our study; first, the research was done in one site so the results can not be generalized to all hospitals. Second, the staff was not blinded about the study. Third, we didn't consider some confounding factors like patients with various clinical manifestations might have diverse satisfaction rate.

Finally we used interviewer questionnaire and interviewer filled up the questionnaire so the patients may be influenced by attitudes of the interviewers and it may include potential biases.

Conclusion

Successfully [a3] delivering services required by patients [a4] admitted in emergency department, depending on service provider meet the needs of patients and they have to know that providing the best services in the shortest possible time is one of the most important responsibility. Present study showed that the lowest satisfaction of patients was from comfort and pleasantness of the waiting area, amount of time spent with doctors and length of wait before visiting by physicians. Therefore try for reducing waiting time, providing a comfortable environment, increasing the time of visit with emergency physicians and enhance service quality based on patients' needs can reduce the patient dissatisfaction.