*Teresa Jackowska1, 2, Małgorzata Czajkowska2
Patient satisfaction and the effectiveness of medical advice at the Hospital Emergency Department – own observations**
Satysfakcja pacjentów i skuteczność udzielanych porad lekarskich w Szpitalnym Oddziale Ratunkowym [ndash] obserwacje własne
1Department of Pediatrics, Centre of Postgraduate Medical Education, Warsaw
Head of Department: prof. Teresa Jackowska, MD, PhD
2Department of Pediatrics, Father Jerzy Popiełuszko "Bielański" Hospital, Independent Public Health Care Institution in Warsaw
Head of Department: prof. Teresa Jackowska, MD, PhD
Streszczenie
Wstęp. Zgodnie z aktualnym rozporządzeniem Ministerstwa Zdrowia w Szpitalnym Oddziale Ratunkowym (SOR) ma miejsce wstępna diagnostyka choroby oraz podejmowane powinny być działania niezbędne dla stabilizacji funkcji życiowych osób, które znajdują się w stanie nagłego zagrożenia zdrowotnego.
Cel pracy. Celem pracy była analiza jakości i skuteczności udzielonych świadczeń medycznych oraz przyczyn zgłoszeń do Szpitalnego Oddziału Ratunkowego (SOR).
Materiał i metody. Retrospektywne badanie ankietowe, składające się z 21 pytań zamkniętych, przeprowadzone zostało telefonicznie wśród 153 rodziców, przez jednego lekarza. Jedynym kryterium włączenia był czas wypisu z SOR-u dziecka [ndash] powyżej 48 godzin.
Wyniki. Spośród włączonych do badania dzieci do SOR-u skierowanych było 54,9% (84/153) dzieci, pozostałe 45,1% (69/153) zgłosiło się bez skierowania. 46,4% (71/153) wymagało badań diagnostycznych. 34% (52/153) otrzymało doraźne leczenie. 94,8% (145/153) ankietowanych rodziców uważało, że wstępna ocena stanu pacjenta była przeprowadzona sprawnie i szybko. 77,1% (118/153) pozytywnie oceniło warunki lokalowe w SOR-ze. Kompetencje personelu medycznego (lekarskiego i pielęgniarskiego) pozytywnie oceniło odpowiednio 92,8 i 90,8% ankietowanych. 91,5% (140/153) rodziców oceniło, że uzyskało informację o dalszym postępowaniu w przypadku pogorszenia się stanu dziecka. 90,2% (138/153) rodziców poinformowało, że zastosowało się całkowicie do zaleceń lekarskich. U 80,4% (123/153) pacjentów rodzice zauważyli poprawę stanu dziecka. 62,8% (96/153) dzieci wymagało ponownej porady lekarskiej, ale w 69,8% (67/96) były to wizyty kontrolne.
Wnioski. Jakość i skuteczność udzielanych świadczeń medycznych w SOR-ze została oceniona bardzo wysoko.
Summary
Introduction. According to the current guidelines of the Ministry of Health, the emergency department serves two main purposes: conducting diagnostic procedures to indicate an initial diagnosis of the patient and administering the necessary procedures to stabilize the patient whose health is at immediate threat.
Aim. The aim of this study was to analyse the quality and efficiency of medical services provided and the reasons for reporting at the Hospital Emergency Department (ED).
Material and methods. The results of a retrospective survey consisting of 21 closed-end questions were analysed and interpreted. The survey was carried out via phone and was conducted by a doctor among 153 parents of patients. The sole criterion of inclusion was the period of being discharged from the Hospital Emergency Department [ndash] over 48 hours.
Results. Among the patients participating in the study, 54.9% (84/153) of the children had been referred to the ED, and the remaining 45.1% (69/153) reported without a referral. Diagnostic tests were necessary for 46.4% (71/153) of the patients and 34% (52/153) of them were provided with emergency treatment. 94.8% (145/153) of the respondents considered preliminary assessment of the patient’s condition fast and efficient. 77.1% (118/153) of the respondents assessed the conditions of the emergency facilities positively. The qualifications of the medical personnel (doctors and nurses) were assessed positively by 92.8 and 90.8% of the respondents, respectively. 91.5% (140/153) of the respondents stated that they were provided with information concerning further procedure in the case of deterioration in the child’s condition. 90.2% (138/153) of the respondents claimed to have fully complied with the medical recommendations. The respondents observed improvement in the child’s condition in 80.4% (123/153) of the patients. 62.8% (96/153) of the children required medical advice again, but 69.8% (67/96) of them were follow-up visits.
Conclusions. The quality and efficiency of medical services at the ED were assessed to be very high.
Introduction
A Hospital Emergency Department (ED) is an organisational unit of the hospital and the State Medical Rescue established with the goal of providing medical services for patients in the condition of a sudden threat to life (1). The operation of the ED consists in preliminary assessment and diagnostics as well as starting treatment to the extent necessary to stabilise life functions of the patient. Not only those requiring immediate medical help and/or hospitalisation reach Hospital Emergency Departments, but also outpatients. Such an organisation of health care contributes to great overload of Hospital Emergency Departments, extending waiting time for the visit among patients requiring immediate medical assistance. In fact, preliminary division is always applied (saturation, pulse, temperature measurement) [ndash] into patients requiring immediate, or faster help as well as those who can wait. However, lacking thorough medical history and examination of the child, the doctor finds it hard to determine whether the patient’s life is under threat. The patient being brought by the Emergency Service or having a referral is not enough, but often misleading when making the decision concerning the severity of the patient’s condition. It is also often the cause of conflicts among the waiting patients, as in determining the sequence of taking care of a child, the decisive factor should be the clinical condition of the child, rather than the sequence or mode of being admitted. The transformation of spatial organisation of the Hospital Emergency Departments in the period of 2008-2011 had an impact on the level of accessibility of those facilities nationwide and within particular provinces (2).
Despite the fact that Hospital Emergency Departments provide a lot of medical services daily, a vast majority of patients continue outpatient treatment due to the lack of indications to hospitalisation, the doctor has no knowledge whether the therapeutic decisions, or refusal to admit the child to hospital were good decisions. It results from the lack of a system monitoring further situation of the patients discharged from the Hospital Emergency Departments, or the efficiency of the recommendations concerning further procedure. Moreover, there is no habit among patients to inform the General Practitioner, either by means of an electronic system on visiting the Hospital Emergency Department, or Night Medical Advice, as the situation is in other countries. Therefore, the operations of Hospital Emergency Departments, being the place of many thousands of hospitalisations, generating huge costs in the budget of every hospital, at very low rate of subsidies granted by the National Health Fund are not verified by the payer at all (www.mz.gov.pl/system-ochrony-zdrowia/panstwowe-ratownictwomedyczne/szpitalne-oddzialy-ratunkowe).
The majority of the analyses conducted, specifying the satisfaction and the efficiency of the medical services provided, applied to persons subject to hospitalisation or further procedure among patients following being discharged from the hospital (3). Additionally, the possibility to issue own opinion by the patients is limited. The majority of questionnaires are posted on hospitals’ websites, which may pose a barrier for some patients as regards the availability of questionnaires. Furthermore, questionnaires are most often filled in by unsatisfied persons, which may be misinterpreted.
Aim
The objective of the paper was to:
1. Assess the quality and the efficiency of the services provided by the medical personnel of the Hospital Emergency Department.
2. Assess the conditions of stay at the Hospital Emergency Department by patients who [ndash] according to the doctor-on-duty [ndash] required no hospitalisation.
3. Analyse the reasons for coming to the Hospital Emergency Department.
Material and methods
Analysis covered the data from the survey obtained from telephone conversations with parents of children subject to medical services at the paediatrics part of the Hospital Emergency Department of Father J. Popiełuszko “Bielański” Hospital in Warsaw. The research lasted two weeks (from 1 March 2015 to 16 March 2015). The period was selected randomly. Initially, it was planned to conduct phone calls within longer periods of time (6, 3 or 1 month), but the number of children reporting at the Hospital Emergency Department in the period of the two-week-research, who did not require hospitalisation was huge, so we decided it would prove reliable for the analysis carried out (e.g. in March, 521 patients reported at the Hospital Emergency Department, out of whom 66.2%, namely 345, were rejected).
156 telephone calls were conducted. Three (1.92%) people refused to provide information via the phone. The following patients were excluded from the research:
– not subject to hospitalisation,
– whose parents resigned, at their own request, from services prior to the child being examined by the doctor or prior to issuing full medical documentation and recommendations concerning further outpatient treatment.
Further analysis covered 153 surveys obtained from the parents of 49% (75/153) of the girls and 51% of the boys (78/153), being the patients of the Hospital Emergency Department. 49.7% (76/153) of the children, whose parents answered the questions included in the survey were aged over 3, 24.2% (37/153) aged between 1 and 3, 24.8% (38/153) aged between 2 and 12 months, while 1.3% (2/153) aged below 1 month (fig. 1).
Fig. 1. Characteristics of the material
69.9% (107/153) of the parents answering the question had higher education, 23.5% (36/153) high school level education, 2% (3/153) elementary education and 3.3% (5/153) vocational. Two parents (1.3%) provided no data.
Medical documentation of the Hospital Emergency Department provided the following data: age and gender of the patient, mode of referral to the hospital, referring doctor’s diagnosis, diagnostic test performed at the Hospital Emergency Department, type of emergency treatment applied, indications for antibiotics therapy in outpatient settings.
Phone calls were made by one doctor asking questions from the prepared survey. The survey comprised of 21 closed-end questions, out of which 2 questions made it possible to provide additional commentary. In order to standardise the scheme of the call, options of answers were prepared that were supplemented after being provided with an answer by the parent/guardian. The questions pertained to three categories: the quality and efficiency of the services provided and the assessment of medical personnel’s competences. Phone calls with parents/guardians of the patient took place at least 48 hours after visiting the Hospital Emergency Department. Maximum 3 phone call attempts were made.
Results
54.9% (84/153) of the children reported at the Hospital Emergency Department with a referral, and the remaining 45.1% (69/153) were subject to hospitalisation without a referral (fig. 2). The most common reasons for coming to the Hospital Emergency Department (diagnoses after medical history verification and patient’s examination by the Hospital Emergency Department’s doctor) were: upper respiratory tract infections (28.1%; 43/153) and obstructive bronchitis (15.7%; 24/153), followed by vomiting and/or diarrhoea (15.7%; 24/153). Less common diagnoses included otitis media (7.2%; 11/153), viral infections (5.2%; 8/153), allergies (7.2%; 8/153), laryngitis (4.6%; 7/153) as well as pneumonia (3.9%; 6/153) and pain in the abdomen (3.9%; 6/153). In individual cases, the reason for referral were: pain in lower extremities, neonatal jaundice, poisonings, pain in the thorax, syncopes, pyrexia, lymphadenitis, inflammation near the perineum, foreign body aspiration, incorrect body mass increment, roseola, epistaxis, migraine, arthritis, renal colic, influenza, symptoms of haemorrhage from the alimentary canal.
Fig. 2. Manner of reporting at the Hospital Emergency Department
ES – Emergency Service; NMA – Night Medical Advice; PC – Primary Care
In the group of children that reported at the Hospital Emergency Department without a referral, in 62.3% (43/69) of the cases, parents stated the cause of coming to be the possibility to obtain professional medical assistance. Other reasons for coming to the Hospital Emergency Department include: in 15.9% (11/69) the child being taken to the hospital by the Emergency Service and in 13.0% (9/69) and 8.7% (6/69), respectively, lack of the possibility to obtain medical assistance at the clinic or Night Medical Advice.
Indication to perform diagnostic tests (laboratory, radiological) was the case in 46.4% (71/153) of the children. 34% (52/153) were provided with emergency treatment (tab. 1). Antibiotics were administered in 15.7% (24/153), of which 33.3% (8/24) of the cases covered continuing the previous treatment.
Tab. 1. Emergency treatment at the Hospital Emergency Department (in some cases more than one medical procedure)
| Emergency treatment | Number of patients
N = 52 | % |
| Medicine nebulisation | 20 | 38.5 |
Hydration:
– oral
– intravenous |
7
6 |
13.5
11.5 |
Medicine:
– antipyretics
– sedatives
– relaxants
– antihistamines
– intravenous steroids
– glycerin suppositories |
22
1
1
1
1
1 |
42.3
1.9
1.9
1.9
1.9
1.9 |
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Piśmiennictwo
1. Rozporządzenie Ministra Zdrowia z dnia 3 listopada 2011 r. w sprawie szpitalnego oddziału ratunkowego, art. 34 ustawy z dnia 8 września 2006 r. o Państwowym Ratownictwie Medycznym (Dz. U. Nr 191, poz. 1410, z późn. zm).
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