Parental Satisfaction and Factors Affecting Parental Satisfaction at Pediatric Emergency Unit, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Abstract

Background: Parental satisfaction is an important part of quality care. This is particularly true in emergency departments, which uniquely cannot refuse patients, even when at full capacity. These departments are tasked with the rapid diagnosis and treatment of emergency patients. When parents are actively involved and content with the care their child receives in the hospital, it enhances their understanding of their child’s illness and adherence to the prescribed treatment plan. This study aimed to assess parental satisfaction and identify factors that affect parental satisfaction.

Methods: We conducted a cross-sectional study with parents who visited the pediatric emergency unit from June to September 2022. Trained interns collected the data using a pretested self-administered questionnaire. We analyzed the data and calculated frequencies and percentages for all variables. Binary logistic regression was used to determine associated factors.

Result: In this study, 52.8% of parents were overall satisfied with the emergency service. The highest satisfaction scores were for patient care by doctors and nurses (54.2%), while the lowest scores were for the hospital environment and parental participation (49.6% and 45.4%, respectively). The regression analysis revealed that parental satisfaction was significantly associated with parents' age, occupation and the longer waiting time before seeing a doctor.

Conclusion: The results showed that the hospital service met the mean expectations of half of the parents, but there were significant shortcomings in the hospital environment and the involvement of parents in the care process. The level of satisfaction among parents varied depending on their age, occupation and the time they had to wait before seeing a doctor.

African Relevance

This study on parental satisfaction at a Pediatric Emergency unit in Ethiopia reflects the African context of quality of care and the level of communication between healthcare providers and parents, which affects the outcome of the patients.

To improve the experience of care for children and their families in the emergency department, we need to know and respect the preferences and values that influence parents' trust and confidence in the health system and their willingness to seek care in the future.

Furthermore, this provides critical feedback and guidance for healthcare providers to improve their practice and meet the needs and expectations of parents in the newly developing healthcare systems of Africa.

1. Introduction

1.1. Background

Emergency departments have a unique role in hospitals. They cannot turn away any patient, even when they are full. They also must diagnose and treat emergency cases quickly¹. It is important to measure the satisfaction of patients or guardians with the medical service they receive. This can help improve patient-centered care and policies at medical facilities^2-4.

Satisfaction is how well the service provided by the hospital matches the expectations of the patients. It depends on many factors, such as the personal and social characteristics of the patients and their relatives, their previous experiences, their future hopes, the hospital facilities and how urgent they think their condition is⁵. The pediatric emergency unit admits all critically ill children who need hospital care, except for newborns <7 days old and surgical emergencies that require immediate intervention. Patient satisfaction depends more on the personal, social and medical factors of the patient than on the quality of care they receive⁶.

To improve the experience of care for children and their families in the emergency department, we need to know and respect their preferences and values. A report by the American Academy of Pediatrics suggests some key aspects of family-centered care for patient satisfaction in pediatric emergency care, such as allowing family presence, being culturally sensitive, communicating well, sharing decisions, coordinating with the primary care provider and giving clear discharge instructions⁷. Many studies have shown that parental satisfaction is a vital part of quality care. When parents are involved and satisfied with their child’s care in the hospital, they can better understand their child’s illness and follow their treatment plan^8-11. In a study conducted at the pediatric emergency department of Mayo Hospital, most 60% of the participants were male while, (69.5%) of the participants reported an overall satisfaction rate¹². In a separate study conducted in Ethiopia focusing on the neonatal ICU, a significant majority of the respondents, accounting for 79.6%, were female and out of these, 63% expressed satisfaction with the care received¹³. In Korian pediatric emergency study 40.2% were having overall parental satisfaction while, environmental 33.3% and waiting time satisfaction were (68.3%) but in Greek, Denmark hospital (80.2%), higher parental satisfaction respectively^14-16 36.1%¹⁷. In one of Germen study most (93.4%) of participants were mother and overall parental satisfaction.

According to a study by the Düzce University Faculty of Medicine, there was a strong link between how satisfied the parents were and whether they would suggest their relatives choose the pediatric emergency department. Most of the parents said they would go to the pediatric emergency department again. In the same study, the overall parental satisfaction was 79%¹⁸. According to Mohamed Beshir’s research in Jimma, Ethiopia study which was done in pediatric wards 68% of the caregivers were found to be satisfied¹⁹. In a study conducted by Kibret and his colleagues²⁰ in our hospital’s pediatric wards, 224 parents were evaluated, resulting in an overall parental satisfaction rate of 59.8%. In Tikur Anbessa Specialized Hospital, the parental satisfaction with the care of their children and the emergency environment is not known. The purpose of this research is to assess how satisfied parents are with the services provided by the pediatric emergency unit of Tikur Anbessa Specialized Hospital, which is affiliated with Addis Ababa University and to pinpoint the elements that affect this satisfaction. The goal of our study is to offer valuable insights to healthcare practitioners and administrators to enhance care quality and boost parental satisfaction.

2. Methods

2.1. Study design

Institution-based cross-sectional study.

2.2. Study area and period

This study was done at Tikur Anbessa Specialized Hospital, one of the five specialized referral hospitals in Addis Ababa. The city has 11 sub-cities 100 districts and 48 hospitals in total. Thirteen of these hospitals are public and five are under the Addis Ababa City Health Bureau. Tikur Anbessa has more than 800 beds and serves roughly 370,000 to 400,000 patients each year. The pediatric emergency unit has 45 beds and treats about 9,000 emergency cases each year or 750 each month. The study period was from June 1 to August 31, 2022.

2.3. Source and study population

We selected the parents of children who were admitted to the pediatric emergency unit during the study period as the source of the population. The study population included only the parents who agreed to take part in the study and whose children stayed in the unit for at least 24 hours.

2.4. Sample size

The sample size was determined by, from the previous study done at Tikur Anbessa specialized hospital pediatric ward showed that 40.2% of the parents were not satisfied with 5% marginal error, 95% Confidence Interval (CI) and a none response rate of 10%. Based on this assumption, the actual sample size for the study was determined using the formula for single population proportion.

Where n=Sample size

Z=z value corresponding to a 95% level of significance=1.96

p=expected proportion of parental satisfaction=40.2%=0.4

q= (1-p) = (1-0.4) =0.6

d=absolute precision (5%)

None response rate=10%

Therefore, based on using the above single population proportion formula the sample size can be calculated as:

n= (1.96)2 0.4(1-0.4), n=368

 (0.05)2

However, since the total number of children visited at pediatrics emergency unit per month and even per year is less than 10,000.so, reduction formula was employed as follows 

Where nf = final sample size resulted from the reduction formula

n = calculated sample size using simple proportion formula which is 368

N = total population (total pediatric emergency cases per month) which is an average of 523 visited children per month so

Nf  =368/1+368/523 Therefore nf =216

Adding 10 % to the calculated number the final sample size was 216. So nf =238e included in the study.

2.5. Sampling procedure

The study recruited parents or guardians of pediatric emergency patients who met the inclusion criteria until the minimum sample size 238 was reached. Parents or guardians who were literate in Amharic filled out the questionnaire themselves after giving written consent. For those who were not, the interns interviewed them and completed the questionnaire on their behalf.

2.6. Inclusion and Exclusion Criteria

The study included parents and/or guardians who stayed in the pediatric emergency unit with their children for at least 24 hours during the study period. Parents whose children died in the hospital were excluded from the study.

2.7. Study Variables

2.7.1. Dependent variable

·       Level of parent’s satisfaction whose children are hospitalized.

·       Communication (Information)

·       Hospital environment

·       Parental participation

·       Patient care (both medical and nursing care)

·       Communication (information)

·       Waiting time

2.7.2. Independent variables

·       Parents' socio-demographic characteristics

·       Duration of hospital stay.

·       Frequency of previous hospitalization

2.7.3. Operational definitions: To determine the overall satisfaction level of parents using a 5-point Likert scale, you can apply the following formula to calculate the average satisfaction score: {(total highest score-total lowest score)/2} + Total lowest score, this formula finds the average point between the maximum and minimum possible scores, then adds the minimum possible score to establish the level of satisfaction20-22.

The satisfaction level for each aspect was gauged by the average score. Scores that fell below the average were deemed as unsatisfied, whereas scores that exceeded the average were interpreted as satisfaction. The following were the average scores for the various dependent variables.

General satisfaction - 3.65

Patient care satisfaction - 3.6

Information satisfaction - 3.3

Waiting time satisfaction - 3.09

Hospital environment satisfaction - 3.1

Parental participation satisfaction - 3.03