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Indian Journal of Community Medicine

Parental Perception About Time Segments Spent in Pedratric Out Patient Department

Author(s): H. Singh, D. Singh, V. Arora, R.K. Soni1, P.A. Pooni, B.K. Jain

Vol. 31, No. 4 (2006-10 - 2006-12)

H. Singh, D. Singh, V. Arora, R.K. Soni1, P.A. Pooni, B.K. Jain

Introduction

OPD is the first point of contact with patient and serves as the window to any health care services provided to the community. The care in OPD indicates the quality of services of a hospital and is refl ected by patient’s satisfaction and their perception about the time spent1. Time spent in OPD is one of the factors that may have an impact on the patient’s satisfaction. There are few studies on other aspects of patient care2,3 but there is no study on Parental Perception about time segments spent in the Pediatric OPD from the region and hence the study.

Material and Methods

The parent’s perception about time segments spent in pediatric OPD was assessed at Dayanand Medical College and Hospital, Ludhiana, Punjab in a prospective manner. Subjects for the study comprised of attendants of 104 patients visiting pediatric OPD. One patient each among early and late arrivals was selected randomly twice a week as per allocated OPD days. The time of arrival was recorded. The different time segment spent by the parents were monitored and documented. They were interviewed and requested to complete a questionnaire at the end of the OPD visit. The questionnaire was explained in local language (Punjabi), whenever required. The highlights of it included reason/purpose of the visit; time spent at various stages viz total, waiting, registration, consultation, investigations and procurement of medicines; problems encountered; any complaints; suggestions and level of satisfaction. The parent’s perception of time spent was assessed by using five point Likert’s scale.

The data thus obtained were tabulated. Mean and Standard Deviation was computed. The comparison of Means was done by using Fisher’s Z test in case of large sample size. Unpaired t-test was applied for comparing the two means with n1 + n2-2 degrees of freedom.

Results

The majority (87.5%) of patients belonged to urban areas. 74% were males. Accompanying persons were mother (49%), father (29.8%) and both parents (13.5%). Out of 104 patients 14 were referred by doctors. The age distribution of patients was: 0 – 1 month 5.6% , 1 month – 1 year 38%, 1 – 5 years 29.8%, 6 – 10 years 16.3% and more than 10 years 9.6%. Education level of attendants was: illiterate (5.9%), primary (9.3%), secondary (38.1%), graduate(35.6%) and postgraduates (11.1%). 80% of the mothers were housewives. Father’s occupation was: service (37.8%), business (37.1%), agriculture (20%) and labour (11.1%). The commonly encountered reasons for hospital visit were: upper respiratory infection (29.3%), acute diarrhea (21.3%), failure to thrive (13.3%), bronchial asthma (10.7%) and enteric fever (10.7%)

Table I: Mean Time Spent by the Parents in Different Segments

Time Segment New (a)
(N=29)
Old (b)
(N=46)
Vaccination(c)
(N=29)
a vs c b vs c
Central
registration
4.8 ± 2.6 5.3 ± 4.9 6.7 ± 4.1 2.17* 1.39
Pediatric
registration
4.4 ± 3.3 6.7 ± 9.3 6.6 ± 5.7 1.75 0.06
Waiting-
consultation
21.5±25.5 27.8 ± 30.8 12.6 ± 10.0 1.74 3.09*
Consultation 14.7± 18.1 9.1 ± 5.6 8.6 ± 4.9 1.69 0.51
Investigations** 21.0± 11.5 30.6 ± 28.7 - - -
Medicine
procurement***
8.3 ± 3.9 12.1 ± 5.5 7.6 + 4.6 t 0.41 t 2.37*
Total 55.3±39.5 57.8± 43.6 38.5 ± 14.7 2.15* 2.77*
* Significant difference
** There were 5 new and 8 old patients in this segment
*** There were 12 new and 14 old patients in this segment

The mean time spent by the parents in different segments is shown in Table I. The total time spent was 55.3±39.5 minutes during first visit (new), 57.8±43.6 minutes during the revisit (old) and 38.5±14.7 minutes in vaccination group. The maximum time spent was during investigations (New 210±11.5, Old 30.6±28.7) followed by waiting before consultation (New 21.5±25.5, Old 27.8±30.8).The total time spent in the vaccination group was significantly less as compared to other groups.

There was no significant difference in the total time spent by the parents is OPDs with less or more patients on that day (Table-II). However the time spent for consultation, investigations and medicine procurement showed a significant difference between the two categories. The total time spent in the category of early arrivals (54.8±41.3 min.) was significantly more (p<0.05) as compared to late arrivals (42.0±22.8 min). It was mainly in the time segment of waiting before consultation. There was no significant difference when the other segments were compared.

43.2% of parents perceived that the time spent was reasonable. Further analysis of perception of time spent among different categories showed that it was reasonable in 55.2% of New, 35.7% of Old and 41.4% of Vaccination group. 98% parents were satisfied after the visit.

Table II: Different Time Segments Versus Total Number of Patients on that Day in the OPD.

Time Spent in Minutes Z/t Value  
Time Segment < 50 patients
(N=48)
> 50 patients
(N=56)
 
Central
registration
4.8± 2.9 6.3 ± 5.0 z = 1.87
Pediatric
registration
5.1 ± 5.1 7.0 ± 8.6 z = 1.32
Waiting-
consultation
20.8± 25.0 20.6 ± 21.8 z = 0.04
Consultation 7.9± 3.9 11.4 ± 10.zz6 z = 2.25+
Investigations* 15.8± 7.5 28.8 ± 23.2 t=3.45 $
Medicine
procurement**
10.7 ± 5.5 7.3 ± 3.7 t = 2.15+
Total 46.2±26.8 50.9± 35.4 z = 0.74
* There were 6 patients (< 50) and 7 patients (>50) in this segment
** There were 23 patients (<50) and 19 patients (>50) in this segment.
+ p < 0.05, $ p < 0.01

Discussion

Various surveys have shown that the most important factor in the patient’s choice of a hospital is its perceived quality in addition to other considerations. The total time spent in waiting and consultation in OPD and parental satisfaction are also important factors for creation of a good image of a hospital4.

In this study the maximum time spent during investigations may be because of wild search of laboratory, waiting and sample collection. The possible solution for this can be adequate guidance to the parents and collecting samples in the respective OPDs. The greater time taken for waiting before consultation may be sorted out by appropriate distribution of patients among all the consultants and also by having separate queues for old and new patients, as new patients need more time for history and workup. Guasco G et al from Pakistan reported median waiting time of 30 minutes and average consultation time of 13.89 minutes5.

The time by old and new cases at central registration may be affected by common queues for patients from all departments. Similarly substantial time spent by the vaccination group for procuring medicines may be because of common drug store for patients from all OPDs. A separate arrangement for vaccination group may solve this problem.

The significantly more time spent for consultation in the group with more than 50 patients on the day may be because of the wide range of time spent. The total time spent by the attendants of early arrivals was significantly more (p<0.05) as compared to late arrivals. This seems to be an important observation because it is a common feeling that time spent is less if one arrives early in the hospital. The possible reasons for this may be (i) late arrival of the consultants (ii) less number of consultants in the morning and (iii) greater time spent for consultation. Modern methods of communication, good public relations can help in creating a good and positive image and to cut short the time spent.

References

  1. Patient satisfaction. In:Organisation and management of hospitals, Practical Manual of PGDHHM 03, IGNOU 2001,pp 14-25.
  2. Demir C, Celiky. Determinants of patient satisfaction in a military teaching hospital. J Healthcare Quality 2002;24:30-34.
  3. Malley PG, Omori DM, Landry FJ, Jackson J and Kroenkek. A prospective study to access the effect of ambulatory teaching on patient satisfaction. Academic Medicine 1997,72:1015-1017.
  4. Undritz N. Does the hospital need an image ? Hospital Management International 1989,195-196.
  5. Guasco G , La Mantia A, Cuniolo A. Implications for the practice of a patient expectation and satisfaction survey at a teaching hospital in Karachi, Pakistan. J Pakistan Medical Association 2003,53:122-125.

Department of Pediatrics and Community Medicine1, Dayanand Medical College & Hospital, Ludhiana, Punjab.
Email: [email protected]
Received: 16.12.04

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