PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-8 | Issue-7 | July-2019 | PRINT ISSN No.
2250 - 1991
ORIGINAL RESEARCH PAPER Management
SATISFACTION SURVEY OF ATTENDANT OF
PATIENTS ADMITTED IN INTENSIVE CARE
KEY WORDS:
UNIT OF TERTIARY CARE GOVERNMENT
HOSPITAL IN INDIA
Dr Anuj Vashisht MBBS, MD (HA), Hospital Administrator, Military Hospital, Meerut
Dr Alok MBBS, MHA (AIIMS, New Delhi), Army Hospital (R & R), New Delhi
Kulsrestha* *Corresponding Author
INTRODUCTION satisfaction with care (14 items) and satisfaction with decision
“Quality care” by Institute of Medicine has been defined as making (10 items). Each item asks family members to rate
safe, timely, effective, efficient, equitable, and patient-centred their satisfaction with a specific aspect of care (eg, “How well
care. '''–(1) Patient-centeredness is a complex concept which did ICU staff assess and treat your loved one's pain?”). All
is reflected in how satisfied patients and their families are with items use a 5-point Likert scale (eg, excellent, very good,
healthcare that they have received. The patient centred model good, fair, and poor), except that one item uses a dichotomous
includes both professional care as well as building a good scale. All items give the response option “not applicable.”
rapport with the patients and their families. Establishing good Their level of satisfaction was recorded by selecting
relationships improves patient care, clinical outcomes and responses ranging from poor=1, fair=2, good=3, very good=4
hospital image.(2) and excellent=5. Scores were linearly transformed to range
from 0 to 100.(5)
The critically ill patients admitted in ICU are generally not in a
condition to make their own decisions either due to illness or Socio-demographic details like age and sex were also
delirium. The ICU setting is a stressful environment due to obtained in the questionnaire. The date of admission and
frequent uncertainty, complex technologies, interdisciplinary other details were recorded from the hospital records. The
decision making, and high patient mortality. The family data was then analysed using appropriate statistical software
members or patient's attendant play an important role in daily
decision making, participation in health care and personal RESULTS
support. And most often, their needs, expectations and In the present study, a total of 57 patient’s attendants were
satisfaction levels are side-lined or ignored due to the interviewed. The mean age of the patient’s attendant was
overworked hospitals and staff. This can lead to anxiety, 40.35 ± 12.13 [Link] age ranged from a minimum of 18 years
depression and PTSD among the family members of the to a maximum of 75 years. The age distribution of the patient’s
patient.(3) Meeting the needs of family's members of patients attendant is shown in Table 1. Among the respondents, 27
in the intensive care unit (ICU) is a primary responsibility of (47.4%) were males and 30 (52.6%) females. The relation of the
ICU physicians and nurses and an important criterion in the attendants to the patients is shown in figure 1.
assessment of the quality of care in the ICU. The satisfaction of
family members with ICU care, decision-making and Table 1: Age Distribution of the Respondents
information, and their empowerment to contribute towards Age (years) n = 57 %
patient care as near relatives, is being perceived as an
<20 3 5.3
important aspect of the general quality of ICU care.(4)
21-30 7 12.4
While the literature is abundant on patient satisfaction 31-40 24 42.1
surveys, however, the satisfaction level of a patient's attendant 41-50 12 21.2
who plays an essential role in the treatment process of the 51-60 7 12.4
patient also needs highlighting. The study was carried out to >60 4 7.2
assess the satisfaction of the family members/attendants of Fig 1: Relation of the attendants to the patient.
the adult patients admitted in ICU of the tertiary care hospital
of Western Maharashtra.
MATERIALS AND METHODS
The present study was a prospective analysis of patient's
attendants (n=57) who were admitted in ICU from April 2018
to Jun 2018 at a tertiary care hospital of Western Maharashtra.
Only one attendant of all the patients admitted in this study
period was interviewed. The study was approved by the
institutional ethical committee and the prior consent was
taken from the patient's attendants. The data was collected by
the principal investigator using FS-ICU-24 Questionnaire. (3)
Details of the level of satisfaction are shown in Table 2 and
Family Satisfaction in the Intensive Care Unit 24 (FS-ICU 24)
most of the time it was excellent to a very good and good level
survey consists of two domains (overall care and medical
of satisfaction. The environment of the ICU waiting area was
decision-making). This scoring approach provides a total
marked poor by 24 (42.1%) respondents (17.85 ±21.58)
satisfaction score (24 items), as well as subscale ratings for
Table 2. Details of Patient Attendant Satisfaction.
Excellent Very Good Good Fair Poor Mean SD Median IQR
Concern & Caring by ICU Staff 20 (35.1) 30 (52.6) 7 (12.3) - - 80.70 16.3 75 25
Pain Management: How well 6( 10.5) 13 (22.8) 5 (8.8) - - 76.04 17.25 75 18.75
the ICU staff assessed and
treated your family member's
symptoms.
50 [Link]
PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-8 | Issue-7 | July-2019 | PRINT ISSN No. 2250 - 1991
How well the ICU staff assessed 1(1.8) 6(10.5) 12 (21.1) - - 59.37 12.9 50 25
and treated your family
member's breathlessness.
How well the ICU staff assessed - 11 (19.3) 13 (22.8) - - 59.37 12.93 50 25
and treated your family
member's agitation.
Consideration of your Needs 8 (14.0)) 32 (56.1) 14 (24.6) 2 (3.5) - 71.87 20.86 75 43.75
How well the ICU staff provided 7 (12.3) 26 (45.6) 21 (36.8) 3 (5.3) - 66.66 20.41 75 25
emotional support
The teamwork of the ICU staff 24 (42.1) 27 (47.4) 6 (10.5) - - 82.73 16.08 75 25
providing care to your family
member (patient)
Concern, Courtesy, Respect by 23(40.4) 23 (40.4) 10 (17.5) 1 (1.8) - 78.57 19.57 75 25
ICU Staff
Skill and Competence of ICU 30 (52.6) 23 (40.4) 4 (7.0) - - 85.71 14.75 75 25
Nurses: How well the nurses
cared for your family member
How do you rate frequency nurses 7 (12.3) 33 (57.9) 15 (26.3) - - 70.83 16.48 75 25
communicated to you about your
family member's condition?
Skill and Competence of ICU 39 (68.4) 15 (26.3) 2 (3.5) - - 90.47 13.47 100 25
Doctors: How well doctors cared
for your family member.
The Environment/ general 27 (47.4) 22 (38.6) 6 (10.5) - - 86.30 15.81 100 25
atmosphere of ICU
The Environment/ Atmosphere - 2 (3.5) 11 (19.3) 10 (17.5) 24 (42.1) 17.85 21.58 0 50
in the ICU Waiting Room
How satisfied are you with the 20 (35.1) 24 (40.4) 14 (24.6) - - 77.63 19.29 75 37.50
level of healthcare your relative Complete Very Sat Mostly Slightly Very
is receiving? sat sat dissat dissat
How do you rate the frequency 20 (35.1) 14 (24.6) 23 (40.4) - - 74.54 21.77 75 50
of Communication with treating
Doctors about your family
member's condition?
Ease of getting information: 9 (15.8) 24 (42.1) 18 (31.6) 6 (10.5) - 65.90 22.23 75 25
Willingness of ICU staff to
answer your questions
Understanding of Information: 11 (19.3) 28 (49.1) 17 (29.8) 1 (1.8) - 71.81 18.66 75 25
How well ICU staff provided you
with explanations that you
understood
The honesty of Information: 20 (35.1) 30 (52.6) 3 (5.3) 2 (3.5) - 80.90 17.97 75 25
Perceived honesty of
information provided to you
about your family member's
condition
Completeness of Information: 14 (24.6) 33 (57.9) 9 (15.8) 1 (1.8) - 76.81 17.24 75 25
How well ICU staff informed you
about what was happening to
your family member and why
The consistency of information 15(26.3) 27 (47.4) 12 (21.1) 3 (5.3) - 74.09 19.81 75 50
provided to you about your
family member's condition (Did
you get a similar story from the
doctor, nurse, etc.)
Inclusion in decision making 5 (8.6) 31 (53.4) 21 (36.2) - - 67.98 15.49 75 25
process: How well the staff Very Slightly Neither Slightly Excluded
involved you in major decision- Included included Included excluded
making process? nor
excluded
Supportduring decision making 5 (8.6) 31 (53.4) 21 (36.2) - - 67.98 15.49 75 25
process: How well ICU staff very somewhat Neither slightly unsuppor
supported you when major supportive supportive unsuppoe ted
decisions were made? rted
How do you rate your control 4 (6.9) 34 (58.6) 20 (34.5) - - 67.98 14.75 75 25
over the patient care activities Good Adequate Neither Some Out of
for your family member? Control Control Control Control
When making decisions, did 50 (86.2) 7 (13.8) - - - 85.96 35.04 100 0
you have adequate time to have Had More time
your concerns addressed and adequate required
questions answered? time
[Link] 51
PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-8 | Issue-7 | July-2019 | PRINT ISSN No. 2250 - 1991
Characteristics of the FS-ICU-24 overall family satisfaction The response rates in these two question of the FS-ICU/Care
score and domain scores are summarised in Table 3. The domain were< 70%. The Not applicable responses for these
responses to pain, breathlessness and agitation management two questions on breathlessness and agitation management
were less than 70%. Thus, the FS-ICU/Total score excluding were 57.7% and 66.6% respectively, thus, bringing a
the three questions of care domain (pain, breathlessness and difference in the results.
agitation management) is 73.57 ±19.83.
The overall grading in our study was found to be very good.
Table 3: FS-ICU_24 overall family satisfaction and domain However, in response to the ICU waiting area, the response
score was mostly poor 24 (42.1%). This was not similar to any other
Score Mean SD Median previous studies(2). This highlights the importance of
Overall Family Satisfaction (FS-ICU 72.55+14.27 75 improving the environment of the waiting area of the ICU as
/Total) well, as it drastically affects the family’s satisfaction level.
Satisfaction with Care Domain (FS- 73.44+ 9.79 75
The study has its own limitations. First, the study was carried
ICU/Care)
out in a single centre of a tertiary care hospital of Western
Satisfaction with Decision- making 73.39+ 6.826 75
[Link], the generalisability of the results to the other
domain (FS-ICU/ Domain)
hospitals may not be appropriate. Also, the respondents were
On performing chi-square test, the association between the those whose sick members were still undergoing treatment in
relationship of patient’s attendant and pain management was the hospital. Therefore, they might have given socially
found to be statistically significant (chi-square value 25.82, p- acceptable answers resulting in social desirability bias.
value = 0.04). Also, the association between the relationship of
patient’s attendant and completeness of information was CONCLUSION
found to be statistically significant (chi-square value 30.355, p Family satisfaction data provide one indicator of the quality of
value=0.011). None of the other parameters showed any care. Patients and relatives are the best sources of information
significant association with patient’s attendant relation, on the various aspects of professional health care as well as
gender and age. the soft skills and rapport building of the health care workers.
The satisfaction levels of the family members were mostly
DISCUSSION comparable to other studies. The factors identified like the
The ICU family satisfaction carried out in our study showed waiting area of ICU and other independent factors associated
the overall family satisfaction of 72.55 ±14.27. The scores for with the family member’s satisfaction can provide the right
FS- ICU/Care and FS-ICU/ DM were 73.44 ±9.79 and 73.39 direction for hospital improvement.
±6.826 respectively. Another study done by Lam et al showed
the FS- ICU/Total as 72.8 ± 17.2. (2). The results are almost RECOMMENDATIONS
similar to our study. The similar studies conducted in To improve the satisfaction level among the attendant
Germany and America showed better satisfaction scores of measures were suggested like Provision of information
78.3 ± 14.3 and 76.6 ± 20.6 respectively. (6)(7). These can be booklets to attendants, informing about the ICU visiting hours,
owed to the fact that both Germany and America are dos’ and don’t and information about treating physicians and
d eve l o p e d c o u n t r i e s a n d h ave b e t t e r h e a l t h c a re nursing staff. Physicians to have a must formal interaction with
infrastructure. Also, the cultural differences and better the family members explaining the prognosis and modality of
doctor- nurse and patient ratio in developed countries can be treatment planned. Attendants and relatives can be included
attributable to these differences. in the daily care of the patient along with the nursing staff. A
provision for the availability of a counsellor around the clock
The mean age of the patient’s attendant in our study was found to interact with the family members to allay their anxiety and
to be 40.35 ± 12.13 years. The studies done in Canada and the fear would greatly improve the satisfaction. Improvement of
US by Wall et al showed a mean age of 54.2 ± 14.4 years. (5)(2). waiting area amenities and a feedback system for overall
The study conducted in Hong Kong by Lam et al showed the services provided to the patient and attendants would act as a
mean age of 47 years. Most of the attendants in our study were quality improvement measure.
children of the patients, 27 (47.4%). Similar results were found
in the study conducted by Lam et al. However, in the study Conflict of interests
conducted by Wall et al, the attendants were found to be The authors declare that they have no conflicts of interests.
mainly spouses. The differences can be attributed to the fact,
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In our study, the family’s satisfaction level on assessment and
treatment of family member’s breathlessness and agitation
scored less (59.37 ±12.93) as compared to other studies (5).
52 [Link]