Pediatric emergency care outcomes

Previous literature regarding pediatric emergency care outcomes was found in two studies measuring adolescents’ satisfaction with care (Sefrin et al. 2012;

Rutherford et al. 2010) but not emergency care satisfaction of children under 13 years of age. Parents’ satisfaction with pediatric emergency care was studied in four quantitative studies (Macedo & D’Innocenzo 2019; Fitzpatric et al. 2014;

Byczkowski et al. 2013; Locke et al. 2011). ED staff’s perceptions of pediatric care quality were studied with both qualitative (Phonbruk et al. 2018; Peeler et al. 2016) and quantitative methods (Goldman et al. 2018). Studies are

described in table 3.

Children’s assessments of emergency care

In previous studies, adolescents felt that the quality of care they received at an ED was good (Rutherford et al. 2010, Shefrin et al. 2012). The single factor found to decrease satisfaction was the length of waiting time (Shefrin et al.

2012). Adolescents considered important aspects of their care to be the organization of separate waiting rooms for them and the ability to meet professionals alone (Shefrin et al. 2012), as well as the interaction with and appreciation of nursing staff (Rutherford et al. 2010). Adolescents’ satisfaction was not related to the patient’s triage level or LOS (Rutherford et al. 2010).

communication and the comfort of their stay and shortening the LOS (Rutherford et al. 2010).

Parents’ assessments of pediatric emergency care

Locke et al. (2011) and Byczkowski et al. (2013) studied parental satisfaction with children’s ED care and found that satisfaction was enhanced by

collaboration between the physician and nurse (Byczkowski et al. 2013), responding to the needs of the family, and informing about delays (Locke et al.

2011) and shorter waiting times (Byczkowski et al. 2013; Fitzpatric et al. 2014).

The same situation was described in a study in Brazil where a longer waiting time decreased parents’ satisfaction with care (Macedo & D’Innocenzo 2019).

Also, the patient’s acuity level was found to be related to parents’ experience of their child’s care. Parents whose child was classified as semi-acuity were less satisfied with the care than parents of children who were classified as acuity or low-acuity (Fitzpatric et al. 2014).

Nursing staff evaluations of pediatric care quality

There is limited literature on nursing staff evaluations of pediatric care quality.

An Australian study (Phonbruk et al. 2018) with interviews of nurses identified barriers to pediatric patients’ care in parents’ understanding of discharge information. The nurses considered that factors in understanding instructions included difficulties with interaction, parental factors, lack of time and human resources in an ED, and lack of nurses’ skills. Nurses felt that a key factor in providing parents high-quality and useful guidance was their professional skills and previous work experience. (Phonbruk et al. 2018.)

A survey study (Goldman et al. 2018) of general ED staff members’

perceptions of caring for pediatric patients found that physicians and nurses had limited knowledge and skills for caring for pediatric patients and that they suffered emotional tolls from caring for sick children (Goldman et al. 2018). The same situation was established in an interview study (Peeler et al. 2016) pertaining to nursing and medical staff members’ major concern in moving from a mixed ED to a PED. The staff perceived that they didn’t have enough

competence and knowledge needed to provide pediatric care. After a

reorganization, the staff felt that pediatric patients were receiving better-quality care than they were earlier, that they had all the needed equipment for

pediatric care, and that children would not have to wait in the same area as adult patients. (Peeler et al. 2016.)

Table 3. Summary of studies relating to pediatric care outcome (n=9).

Author,

country Purpose Methods Results

Byczkowski

Parents’ satisfaction with their child’s care was enhanced by

the collaboration between physicians and nurses, length of waiting time, and the child’s

pain management.

Parents’ expectations of and satisfaction with their care were not primarily related to the LOS or the care received by their child. Instead, the triage level was found to be related to parents’ experience with their child’s care. Parents whose child was classified as semi-urgent were less satisfied

with the care than parents of children who were classified as

urgent or non-urgent.

Goldman for pediatric patients was challenging due to pediatric patients’ numbers fluctuating.

Also, they reported bearing an emotional toll of caring for sick children. Participants found some deficiencies in the quality

and safety of pediatric patients.

call are related to high satisfaction of reporting delays in care, taking

into account the child’s needs, relieving pain, facilitating the insurance process, and calling home after discharge. ED LOS was not related to patient

satisfaction.

Macedo & patient flow in the

ED.

Cross-sectional survey study of 300 caregivers of pediatric patients.

Caregivers’ lower satisfaction scores were related to shorter

waiting times.

Peeler et al. (2016)

Australia

To describe ED staff members’ nursing staff and 8

members of a

transition to the new model of service and care for pediatric

patients.

Barriers were found to parents’

understanding of discharge information. Barriers were related to communication, resources, staff competencies,

and time constraints and characteristics of the parents.

Nurses thought that effective discharge information is related to nurses’ professional experience and competence to provide useful information to

parents.

Most (95%) adolescents were satisfied with their overall PED experience. LOS, triage acuity, age, and sex were not related

to their satisfaction.

Improvements occurred with shorter ED visits, more interaction with staff members,

and attention paid to the pleasantness of the visit.

Shefrin et

The adolescents were satisfied with their care. Long waiting

times decreased their satisfaction with care. Separate

waiting areas for adolescents and meeting professionals alone were significant factors

for their satisfaction.