Parents' and Carers' Impression of "quality" Within a Paediatric Emergency Department

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2021 Jul 14

PMID 34256736

Authors

Brendan Lacey

Adam West

Simon Craig

Affiliations

Soon will be listed here.

Abstract

Background: Quality improvement systems are needed to overcome the 'Quality Gap' - difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent's/carer's perception of these is unknown. This study aimed to identify what 'quality of care' means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback.

Methods: A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible- no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered "very important", while those scoring at least an 8 were considered "extremely important".

Results: One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what 'quality of care' means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: 'Thorough medical assessment' (84%); 'A triage system' (84%); 'Experienced and knowledgeable staff that are skilled in paediatrics' (77%); 'Resources and equipment available to provide care' (72%); and 'Clear follow up plans and reviews that are communicated and scheduled' (72%). Parents/carers considered existing quality measures as important with 'timely treatment of a critical condition' as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%).

Conclusion: We have elicited what 'quality of care' means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED.

References

Haverman L, van Rossum M, van Veenendaal M, van den Berg J, Dolman K, Swart J . Effectiveness of a web-based application to monitor health-related quality of life. Pediatrics. 2013; 131(2):e533-43. DOI: 10.1542/peds.2012-0958. View

Mangione-Smith R, DeCristofaro A, Setodji C, Keesey J, Klein D, Adams J . The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007; 357(15):1515-23. DOI: 10.1056/NEJMsa064637. View

Kumar B . Patient Safety and Quality Metrics in Pediatric Hospital Medicine. Pediatr Clin North Am. 2016; 63(2):283-91. DOI: 10.1016/j.pcl.2015.11.002. View

Forrest C, Bevans K, Pratiwadi R, Moon J, Teneralli R, Minton J . Development of the PROMIS ® pediatric global health (PGH-7) measure. Qual Life Res. 2013; 23(4):1221-31. PMC: 3966936. DOI: 10.1007/s11136-013-0581-8. View

Stang A, Straus S, Crotts J, Johnson D, Guttmann A . Quality indicators for high acuity pediatric conditions. Pediatrics. 2013; 132(4):752-62. DOI: 10.1542/peds.2013-0854. View

Schaffer P, Vaughn G, Kenner C, Donohue F, Longo A . Revision of a parent satisfaction survey based on the parent perspective. J Pediatr Nurs. 2001; 15(6):373-7. DOI: 10.1053/jpdn.2000.16713. View

Borland M, Shepherd M . Quality in paediatric emergency medicine: Measurement and reporting. J Paediatr Child Health. 2016; 52(2):131-6. DOI: 10.1111/jpc.13077. View

Dainty K, Seaton B, Laupacis A, Schull M, Vaillancourt S . A qualitative study of emergency physicians' perspectives on PROMS in the emergency department. BMJ Qual Saf. 2017; 26(9):714-721. PMC: 5574389. DOI: 10.1136/bmjqs-2016-006012. View

Rosen J, Suresh S, Saladino R . Quality Care and Patient Safety in the Pediatric Emergency Department. Pediatr Clin North Am. 2016; 63(2):269-82. DOI: 10.1016/j.pcl.2015.12.004. View

10.

Elo S, Kyngas H . The qualitative content analysis process. J Adv Nurs. 2008; 62(1):107-15. DOI: 10.1111/j.1365-2648.2007.04569.x. View

11.

Davis T, Meyer A, Beste J, Batish S . Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education. J Am Board Fam Med. 2018; 31(4):550-557. DOI: 10.3122/jabfm.2018.04.170474. View

12.

Alessandrini E, Varadarajan K, Alpern E, Gorelick M, Shaw K, Ruddy R . Emergency department quality: an analysis of existing pediatric measures. Acad Emerg Med. 2011; 18(5):519-26. DOI: 10.1111/j.1553-2712.2011.01057.x. View

13.

McInerny T, Sachdeva R . The American Academy of pediatrics and quality improvement. Acad Pediatr. 2013; 13(6 Suppl):S7-8. DOI: 10.1016/j.acap.2013.01.006. View

14.

Tates K, Zwaanswijk M, Otten R, van Dulmen S, Hoogerbrugge P, Kamps W . Online focus groups as a tool to collect data in hard-to-include populations: examples from paediatric oncology. BMC Med Res Methodol. 2009; 9:15. PMC: 2653071. DOI: 10.1186/1471-2288-9-15. View

15.

Speed E, Davison C, Gunnell C . The anonymity paradox in patient engagement: reputation, risk and web-based public feedback. Med Humanit. 2016; 42(2):135-40. DOI: 10.1136/medhum-2015-010823. View

16.

Male L, Noble A, Atkinson J, Marson T . Measuring patient experience: a systematic review to evaluate psychometric properties of patient reported experience measures (PREMs) for emergency care service provision. Int J Qual Health Care. 2017; 29(3):314-326. PMC: 5890873. DOI: 10.1093/intqhc/mzx027. View

17.

Khoo K, Bolt P, Babl F, Jury S, Goldman R . Health information seeking by parents in the Internet age. J Paediatr Child Health. 2008; 44(7-8):419-23. DOI: 10.1111/j.1440-1754.2008.01322.x. View

18.

Alves D, Szucs P . The demographics of e-mail for emergency medicine research. Am J Emerg Med. 2001; 19(3):192-5. DOI: 10.1053/ajem.2001.21714. View

19.

Bos N, Sturms L, Schrijvers A, van Stel H . The Consumer Quality index (CQ-index) in an accident and emergency department: development and first evaluation. BMC Health Serv Res. 2012; 12:284. PMC: 3447703. DOI: 10.1186/1472-6963-12-284. View

20.

Labovitz J, Patel N, Santander I . Web-Based Patient Experience Surveys to Enhance Response Rates . J Am Podiatr Med Assoc. 2017; 107(6):516-521. DOI: 10.7547/16-001. View