|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2023 | Volume
: 12
| Issue : 1 | Page : 49-54 |
|
Waiting time and patients' satisfaction in the emergency department in Taif city, Saudi Arabia
Amjad Mohammed Jawhari1, Abdulelah Mohammed Alnefaie1, Alsharif Mohammad Alqurashi1, Majid Bashir Yusuf1, Khaled Faisal Alhijjy1, Mohammed Abdullah Alosaimi1, Hashim Mohammad Atallah1, Yasser Hussain Alnofaiey2
1 College of Medicine, Taif University, Al-Taif, Saudi Arabia
2 Department of Internal Medicine, College of Medicine, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| Date of Submission | 08-Dec-2022 |
| Date of Decision | 13-Jan-2023 |
| Date of Acceptance | 17-Jan-2023 |
| Date of Web Publication | 15-Mar-2023 |
Correspondence Address:
Yasser Hussain Alnofaiey
Department of Internal Medicine, College of Medicine, Taif University, P.O. Box 11099, Taif 21944
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjhs.sjhs_147_22
Background: Patients' satisfaction in emergency departments (EDs) could be improved by providing estimates of the expected waiting time. Aim: The aim of this study was to determine waiting time and assess patients' satisfaction in EDs. Setting and Design: A descriptive, cross-sectional study was carried out in Taif city included patients who come to EDs of three main hospitals throughout the period from mid-August to mid-September 2022 if they aged from 18 to 65 years. Materials and Methods: Data were collected through a pretested Arabic version of the Brief Emergency Department Patient Satisfaction Scale questionnaire. Statistical Analysis: Data were entered into the Statistical Package for the Social Sciences (SPSS) software version 26 for Windows. Results: The study included 612 patients. Almost a quarter (23%) aged 25–34 years. Regarding satisfaction of patients with ED, the highest score was observed concerning physicians' care (4.31 ± 0.88) whereas the lowest satisfaction score was reported regarding arrival in reception (AIR) (3.57 ± 1.08). The highest score was observed among those who attended King Faisal Medical Complex (4.19 ± 0.74), whereas the lowest score was observed among those who attended Alhada Armed Forces Hospital (3.75 ± 0.91), P < 0.001. The highest score of satisfaction was observed among patients aged 65 years/above (4.08 ± 0.76), P = 0.041. Non-Saudi patients were more likely to be satisfied compared to Saudi patients (4.33 ± 0.77 vs. 3.89 ± 0.87), P < 0.001. Patients who did not read/write were more likely to be satisfied compared to educated patients (4.23 ± 0.83 vs. 3.89 ± 0.87), P = 0.001. The waiting time exceeded 2 h among 13.9% of patients. With decreasing the waiting time, the patients' satisfaction with ED was increasing, P < 0.001. Conclusion: The overall patients' satisfaction with ED was high; it was lowest regarding AIR. In addition, longer waiting time was associated with patients' dissatisfaction.
Keywords: Emergency department, patients satisfaction, Saudi Arabia, waiting time
How to cite this article:
Jawhari AM, Alnefaie AM, Alqurashi AM, Yusuf MB, Alhijjy KF, Alosaimi MA, Atallah HM, Alnofaiey YH. Waiting time and patients' satisfaction in the emergency department in Taif city, Saudi Arabia. Saudi J Health Sci 2023;12:49-54 |
How to cite this URL:
Jawhari AM, Alnefaie AM, Alqurashi AM, Yusuf MB, Alhijjy KF, Alosaimi MA, Atallah HM, Alnofaiey YH. Waiting time and patients' satisfaction in the emergency department in Taif city, Saudi Arabia. Saudi J Health Sci [serial online] 2023 [cited 2023 Mar 20];12:49-54. Available from: https://www.saudijhealthsci.org/text.asp?2023/12/1/49/371711 |
| Introduction | |  |
Academics, professionals, and those who provide health-care services have all expressed strong concerns about how to improve health-care quality.[1] Critically ill patients require a lot of medical care, and emergency departments (EDs) play a crucial part in that process.[2]
In any health-care system, achieving patient satisfaction is a key objective.[3] Patients' opinions of the care are frequently used to judge the quality of health-care delivery.[4] To increase patient satisfaction, it is important to examine the quality of health care as patients grow more aware about it.[5],[6],[7]
In numerous health-care settings, there is an increased flow of patients in the ED, and consequently, the waiting increases, which adversely impacts the overall patients' satisfaction with provided services.[2]
Many factors that affect patient satisfaction are related to the health-care services and health-care provider while waiting time in the ED has been shown to be an important part of the satisfaction, explanations of the patient's laboratory tests and results, condition, and, reasons for admission have been shown to have a major impact on the level of patient satisfaction. Patients frequently complain about how long they must wait in the department, thus it is something that needs to be improve, as it increases patients' stress and frustration. In addition, long waiting time leads to an increase in the number of patients who leave without being seen.[2],[8]
A minimum amount of time should be considered in an emergency room between the time the patient is admitted and when they are given their medication. It has been documented in Saudi Arabia that patients' satisfaction in ED could be improved by providing estimates of the expected waiting time.[7] This recommendation was also confirmed in the United States (US) as most of the patients would prefer the existence of estimates of the waiting time before being seen by a doctor.[9]
Hence, to improve patients' satisfaction and decrease waiting time, this study was conducted to determine waiting time and patients' satisfaction in the ED in the tertiary care hospitals in Taif city, Kingdom of Saudi Arabia.
| Materials and Methods | | |
This study is a descriptive, cross-sectional study carried out in Taif city, which is located at Saudi Arabia's Western Region, in Mecca Province, with a surface area of 13840 km2 and a height of 1700–2500 meters above sea level. The population in Taif was estimated to be 993,800 according to the census of 1435 (Hijri date).[10]
The study included patients who come to EDs of three main hospitals in Taif city, namely Alhada Armed Forces Hospital (AAFH), King Abdul Aziz Specialist Hospital, and King Faisal Medical Complex Hospital, throughout the period from mid-August to mid-September 2022, if they aged from 18 to 65 years and accept to participate in this study by providing informed consent at the beginning of the questionnaire.
For sample size calculation, the following formula was used:
SS = Z2 × P × (1 − P)/e2.
Where:
SS = Sample Size.
Z2 = (1.96) 2 for a 95% confidence level.
P = “best guess” for prevalence (Population Proportion).
e = Margin of Error which is 5% for a 95% confidence level.
Assuming the population proportion is 50% (P), at a 95% confidence interval (Z = 1.96) with a margin of error of 5% (e), the minimum representative sample was 385. This sample was increased by 10% to be 424 to compensate for nonresponses. A convenience nonprobability sampling technique was adopted to select participants in this study, which were almost equally distributed over the three hospitals.
Data were collected through a pretested Arabic version[11] of the Brief Emergency Department Patient Satisfaction Scale questionnaire.[12] The questionnaire was distributed on patients and their auditors in the EDs of the selected hospitals in Taif city. Non-Arabic speaking patients were excluded from the study.
The questionnaire included 30 questions with a five-point Likert-scale question ranging from 1 (very poor) to 5 (very good), that are categorized into seven domains, namely, waiting time, arrival in reception (AIR), staff of ED (EDS), ED environment (EDE), physician care satisfaction, general patient satisfaction, and patients' family satisfaction. Total and domains' scores were computed for each participant.
After taking ethical approval from the target institution, we obtained written consent and began the interview to complete the questionnaire from participants in the EDs of the three hospitals. A questionnaire was obviously instructed and reminded not to ask any leading questions that might bias the patient's answers in any way. The questionnaire took about 4 min to complete. The participants were guaranteed that any details they provide were kept private and used solely for research purposes. Participants did not pay for their participation in this study, and they were informed that they are able to refuse to answer any questions which they are uncomfortable with. After gathering the data, they were cleared out for any participation that did not meet the inclusion criteria.
A pilot study was carried out on 10% of the total sample size to confirm that the target group understood the material and that the responses provided the required data. The results of the pilot study were not considered in the current study's data analysis.
Likert scale was classified as low if it ranges between 1 and 2.33, moderate between 2.34 and 3.67, and high between 3.68 and 5.[13]
Data entry and analysis
The data were checked for completeness and made sure about matching the inclusion criteria after that coded and classified according to the correct responses. The responses of the participants were categorized depending on their gender, educational level, awareness, and level of knowledge, after that data were entered into the IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. (Armonk, NY: IBM Corp). Categorized data were described as frequency and percentage, whereas continuous data were described as mean and standard deviation. Independent samples t-test was used to compare arithmetic means between two groups, whereas a one-way analysis of variance test was used to compare arithmetic means of more than two groups and statistical significance was determined at P < 0.05.
| Results | | |
The study included 612 patients. [Table 1] summarizes their baseline and demographic characteristics. They were almost equally distributed between the three involved hospitals. Males represented 58% of the participants. Almost a quarter of them (23%) were aged between 25 and 34 years whereas 9.5% were aged 65 years or above. More than half of them (58.3%) were married and majority (90.5%) were Saudi nationals and educated (87.6%). | Table 1: Baseline and demographic characteristics of the participants (n=612)
Click here to view |
Regarding satisfaction of patients with different domains of ED, the highest score was observed concerning physicians' care (4.31 ± 0.88), followed by EDS (4.16 ± 0.90) and EDE (4.02 ± 1.00), whereas the lowest satisfaction score was reported regarding AIR (3.57 ± 1.08). The overall satisfaction was moderate with a score of 3.93 ± 0.87 [Table 2].
The highest score for patients satisfaction with ED was observed among those who attended (KFHC) (4.19 ± 0.74), whereas the lowest score was observed among those who attended (AAFH) (3.75 ± 0.91), P < 0.001. The highest score of satisfaction was observed among patients aged 65 years and above (4.08 ± 0.76), whereas the lowest one was observed among those aged between 55 and 64 years (3.77 ± 1.04), P = 0.041. Non-Saudi patients were more likely to be satisfied with ED compared to Saudi patients (4.33 ± 0.77 vs. 3.89 ± 0.87), P < 0.001. Patients who did not read and write were more likely to be satisfied with ED compared to educated patients (4.23 ± 0.83 vs. 3.89 ± 0.87), P = 0.001. There was no significant difference in satisfaction with EDs in patients according to their gender and marital status [Table 3]. | Table 3: Factors associated with emergency department's patient's satisfaction
Click here to view |
[Figure 1] shows that the waiting time was 10 min or less among 25.7% of patients whereas it exceeded 2 h among 13.9% of patients. | Figure 1: Waiting time among patients visiting the emergency department in Taif Hospitals
Click here to view |
[Table 4] shows that the highest waiting time was observed among patients who attended (AAFH) (96.3 ± 102.9 min) and the lowest was reported among those who attended (KFHC) (58.9 ± 74.8 min), P < 0.001. | Table 4: Comparison of waiting time between different involved hospitals in Taif
Click here to view |
It is evident from [Table 5] that with decreasing the waiting time, the patients' satisfaction with ED increase as the score was 4.16 ± 0.74 among patients who reported a waiting time ranged between 11 and 30 min whereas it was 3.42 ± 0.91 among those who reported waiting time of more than 2 h, P < 0.001. | Table 5: Association between waiting time and patients' satisfaction with emergency departments in Taif hospitals
Click here to view |
| Discussion | | |
The increasing need for health-care services due to increasing populations and limited availability of health-care services leads to overcrowding at EDs,[2] which consequently results in long waiting at EDs and patients' dissatisfaction. This situation has been identified as a public health problem.[14]
Assessing the satisfaction of patients with the provided health-care services at EDs is warranted, and investigating the effect of long waiting times at EDs on patients' satisfaction is essential as identifying the success of health-care organizations is measured and ensured by the satisfaction of patients.[15] Therefore, this study was performed to determine waiting time and assess patients' satisfaction in the ED in three tertiary care hospitals in Taif city, Kingdom of Saudi Arabia.
In the current study, the highest score was observed concerning physicians' care, followed by EDS and EDE, whereas the lowest satisfaction score was reported regarding AIR. The overall satisfaction was moderate with a score of 3.93 ± 0.87 out of a maximum possible of 5. The more satisfaction of patients with physicians' and emergency staff's care than others was also confirmed by Shabbir and Malik,[16] Therefore, more attention should be paid to the reception of patients at EDs upon arrival.
The association of the long waiting time with patients' dissatisfaction observed in the present study was confirmed by others.[7],[10],[17],[18],[19] Furthermore, a significant association between long waiting time and ED overcrowding from one side and the number of patients who leave the ED without being seen from the other side was proved as one of the indicators of patient dissatisfaction with EDs.[20] However, in another recent Saudi study, despite most of the patients who attended ED preferred knowing their expected waiting times, there was no significant association between their satisfaction with ED and waiting time.[5] Recently, Abdelhadi observed no difference in patients' satisfaction with alteration in the waiting period through the surveys (by comparing before and during the COVID-19 pandemic).[21] Furthermore, in the US, patients' satisfaction with waiting times was not improved after providing waiting time estimates.[10]
Interestingly, the present study showed significant variation in waiting time and patients' satisfaction according to the attending (AAFH) the highest score for patients satisfaction with ED and highest waiting time were observed among those who attended (KFHC) while the lowest score and waiting time were observed among those attended (AAFH). We have no clear explanation for that, however, an in-depth investigation is needed to clarify and explain this finding.
Furthermore, patients' satisfaction with ED was more observed among patients aged 65 years and above. The same has been reported by others.[22],[23] However, the explanation of this finding is unclear.
Non-Saudi patients were more likely to be satisfied with ED compared to Saudi patients in the present study. However, this contradicts what has been observed by others that Saudi patients were more satisfied than non-Saudi employees with EDs' services.[11]
Noneducated patients were more likely to be satisfied with ED compared to educated patients in the current study. The same has been observed by others.[17]
In accordance with others,[24],[25] no gender difference regarding patients' satisfaction with EDs was observed in the current study. However, Al-Wathinani et al. observed that male patients were more satisfied with EDs' services compared to females[11] while Son and Yom[23] reported that females were more satisfied with EDs' services than males.
Study strengths and limitations
The study included enough sample size to detect the statistical power and also, and a valid Arabic version questionnaire was utilized for data collection. In addition, it was conducted in three main hospitals in Taif city. However, convenience sampling was utilized. Furthermore, non-Arabic speakers were excluded. Therefore, the generalizability of our results might be affected.
| Conclusion | | |
The overall patients' satisfaction with ED was high; it was highest regarding physicians' care, EDS, and EDE whereas it was lowest regarding AIR. Patients' satisfaction with ED differed according to the hospital, patient's age, nationality, and educational qualification. In addition, longer waiting time was associated with patients' dissatisfaction. Based on the study's findings, further study is recommended to include patients attending other settings in Taif and other Saudi's governorates to have a more comprehensive situation. Increasing the EDs staff is needed to avoid overcrowding and a long waiting list in the EDs of hospitals.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Greig G, Entwistle VA, Beech N. Addressing complex healthcare problems in diverse settings: Insights from activity theory. Soc Sci Med 2012;74:305-12.  |
| 2. | Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018;13:e0203316. |
| 3. | Prakash B. Patient satisfaction. J Cutan Aesthet Surg 2010;3:151-5. [ PUBMED] [Full text] |
| 4. | Grøndahl VA, Kirchhoff JW, Andersen KL, Sørby LA, Andreassen HM, Skaug EA, et al. Health care quality from the patients' perspective: A comparative study between an old and a new, high-tech hospital. J Multidiscip Healthc 2018;11:591-600. |
| 5. | Alrajhi KN, Aljerian NA, Alazaz RN, Araier LB, Alqahtani LS, Almushawwah SO. Effect of waiting time estimates on Patients satisfaction in the emergency department in a tertiary care Center. Saudi Med J 2020;41:883-6. |
| 6. | Löflath V, Hau EM, Garcia D, Berger S, Löllgen R. Parental satisfaction with waiting time in a Swiss tertiary paediatric emergency department. Emerg Med J 2021;38:617-23. |
| 7. | Abolfotouh MA, Al-Assiri MH, Alshahrani RT, Almutairi ZM, Hijazi RA, Alaskar AS. Predictors of patient satisfaction in an emergency care Centre in central Saudi Arabia: A prospective study. Emerg Med J 2017;34:27-33. |
| 8. | Magaret ND, Clark TA, Warden CR, Magnusson AR, Hedges JR. Patient satisfaction in the emergency department – A survey of pediatric patients and their parents. Acad Emerg Med 2002;9:1379-88. |
| 9. | Shaikh SB, Witting MD, Winters ME, Brodeur MN, Jerrard DA. Support for a waiting room time tracker: A survey of patients waiting in an urban ED. J Emerg Med 2013;44:225-9. |
| 10. | |
| 11. | Al-Wathinani AM, Aldawsari S, Alhallaf M, Alotaibi Y, Alrazeeni D, Ageli MM, et al. Assessment of emergency department satisfaction level in Saudi Arabia general hospital. Saudi J Anaesth 2022;16:4-9. [Full text] |
| 12. | Atari M, Atari M. Brief emergency department patient satisfaction scale (BEPSS); development of a new practical instrument. Emerg (Tehran) 2015;3:103-8. |
| 13. | Vagias WM. Likert-Type scale Response Anchors. Clemson International Institute for Tourism & Research Development, Department of Parks, Recreation and Tourism Management. Clemson University; 2006. |
| 14. | Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: An international issue. Intern Emerg Med 2015;10:171-5. |
| 15. | Manzoor F, Wei L, Hussain A, Asif M, Shah SIA. Patient satisfaction with health care services; An application of Physician's behavior as a moderator. Int J Environ Res Public Health 2019;16:3318. |
| 16. | Shabbir A, Malik SA, Malik SA, van der Wiele T. Measuring patients' healthcare service quality perceptions, satisfaction, and loyalty in public and private sector hospitals in Pakistan. Int J Qual Reliab Manag 2016;33:538-57. |
| 17. | Abass G, Asery A, Al Badr A, AlMaghlouth A, AlOtaiby S, Heena H. Patient satisfaction with the emergency department services at an academic teaching hospital. J Family Med Prim Care 2021;10:1718-25. [Full text] |
| 18. | Soleimanpour H, Gholipouri C, Salarilak S, Raoufi P, Vahidi RG, Rouhi AJ, et al. Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran. Int J Emerg Med 2011;4:2. |
| 19. | Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva sub-divisional health center, Fiji, 2018: A mixed method study. Front Public Health 2019;7:183. |
| 20. | Weiss SJ, Ernst AA, Derlet R, King R, Bair A, Nick TG. Relationship between the national ED overcrowding scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med 2005;23:288-94. |
| 21. | Abdelhadi A. Patients' satisfactions on the waiting period at the emergency units. Comparison study before and during COVID-19 pandemic. J Public Health Res 2021;10:1956. |
| 22. | Taylor C, Benger JR. Patient satisfaction in emergency medicine. Emerg Med J 2004;21:528-32. |
| 23. | Son H, Yom YH. Factors influencing satisfaction with emergency department medical service: Patients' and their companions' perspectives. Jpn J Nurs Sci 2017;14:27-37. |
| 24. | Aragon SJ, Gesell SB. A patient satisfaction theory and its robustness across gender in emergency departments: A multigroup structural equation modeling investigation. Am J Med Qual 2003;18:229-41. |
| 25. | Alazmi SF. A comparative study of patients' satisfaction with emergency departments in governmental general hospitals, Kuwait. JHIPH 2018;48:50-7. |
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|
Search Pubmed for