|ORIGINAL RESEARCH REPORT
|Year : 2014 | Volume
| Issue : 2 | Page : 44-46
An audit of parental satisfaction of pediatric day case surgery at the Lagos University Teaching Hospital
Olumide A Elebute1, Adesoji O Ademuyiwa2, Justina O Seyi-olajide1, Christopher O Bode2
1 Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Web Publication||8-Dec-2014|
Olumide A Elebute
Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, PMB 12003, Idi-Araba, Lagos
Source of Support: None, Conflict of Interest: None
Background: In recent past, there has been a gradual increase in the volume of patients treated on a day case basis in our center. However, no study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Objectives: To determine the level of parental satisfaction with pediatric day case surgery at the Lagos University Teaching Hospital. Patients and Methods: A total of 101 parents or the patient's caretakers whose wards had day case surgery were administered a self-completed questionnaire on the first postoperative day visit at the surgical outpatient clinic. The questions assessed parental satisfaction with the following: (a) Communication with doctors (surgeons and anesthesiologists), (b) Physical conditions of the theatre environment, (c) Staff's care, (d) Need to care for the child at home, and (e) Postoperative complication. Result: There were 101 respondents with an age range of 22-56 years (mean 35.05 ± 6.85). Eighty-seven (86%) of the respondents were satisfied with the amount of information they obtained from their doctors before the operation; 43 (42.6%) were satisfied with the waiting time, whereas 47 (46.5%) were satisfied with the fasting time. However, 26 (25.7%) of the respondents were dissatisfied with the waiting room environment and 87 parents (87.1%) were dissatisfied with the nursing care. Conclusion: Most parents are satisfied with pediatric day case surgery care. Some adjustments, however, need to be made on reducing the waiting and fasting time of the patients and improving both the waiting room environment and the nursing care in order to increase its acceptance.
Keywords: Day case surgery, parental satisfaction, pediatric
|How to cite this article:|
Elebute OA, Ademuyiwa AO, Seyi-olajide JO, Bode CO. An audit of parental satisfaction of pediatric day case surgery at the Lagos University Teaching Hospital. J Clin Sci 2014;11:44-6
|How to cite this URL:|
Elebute OA, Ademuyiwa AO, Seyi-olajide JO, Bode CO. An audit of parental satisfaction of pediatric day case surgery at the Lagos University Teaching Hospital. J Clin Sci [serial online] 2014 [cited 2021 Jun 25];11:44-6. Available from: https://www.jcsjournal.org/text.asp?2014/11/2/44/146501
| Introduction|| |
The pediatric day case surgery has been gaining popularity in many centers for such reasons as the reduction in waiting list and risk of nosocomial infection, common with inpatient treatment. The other benefits include lowered cost for the patient and early return to the home environment.  Although a novel entity in this part of the world there is a growing shift from the traditional in-house management to the same day surgical treatment as it ensures maximization of material as well as human resources. 
True satisfaction with the quality of treatment is obtained once the care proffered meets the expectation of the patients or parents.  Client satisfaction is an important index of surgical outcome as it assesses the effectiveness and quality of service output which is a very useful audit parameter in ensuring service improvement. 
The audit commission in the United Kingdom advocates a periodic systematic appraisal of the patient's view as a means of monitoring the quality of care.  Such knowledge provides valuable information to the health care provider as to what areas need to be given particular attention so as to ensure optimal service delivery. In Nigeria, where there is no central monitoring department, the onus rest on each health institution to carefully monitor its day case surgery unit and to ensure that efficiency correlates with the quality of care given and not otherwise.
There are only a few studies that have addressed this topic in Africa to the best of the author's knowledge. This work therefore proposes to audit pediatric surgical day case practice at the Lagos University Teaching Hospital focusing on determining the level of parental satisfaction with the same day surgery.
| Patients and methods|| |
The study is a prospective study over a year period. The Hospital's Ethics Committee approved the study. The patients scheduled for surgery were assessed in the pediatric outpatient clinic and the information obtained for each of the patients included age, sex, diagnosis, and the operation planned.
The parents or the patient's caretakers were given a self-completed questionnaire on the patient's first postoperative clinic visit that coincided with the fifth postoperative day. The questions asked assessed parental satisfaction with the following areas: (a) Communication with doctors, i.e. surgeons as well as anesthesiologists, (b) Physical conditions of the theatre environment, (c) Staff's care, (d) Need to care for the child at home, and (e) Postoperative complications.
The degree of satisfaction was measured using a modified Likert scale with a score of 1 representing satisfaction, 2 not sure, and 3 showing dissatisfaction.
The parents or caretakers who refused to fill the questionnaires and those patients who had unplanned ward admissions were excluded from the study. The responses were analyzed using the Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, USA).
| Results|| |
There were 101 respondents with an age range of 22-56 years (mean 35.05 ± 6.85). Eighty-seven (86%) of the respondents were satisfied with the amount of information they obtained from their doctors before the operation; 50 (49.5%) were satisfied with the waiting time, whereas 45 (44.6%) were satisfied with the fasting time. Eighty-eight parents (87.1%) were dissatisfied with nursing care while 81 (80.2%). Seventy (73.7%) of the respondents were dissatisfied with adequacy of pain control, 89 (88.1%) were dissatisfied with control of postoperative nausea and vomiting (PONV). However, 26 (25.7%) of the respondents were satisfied with the waiting room comfort [Table 1]. Sixty-five (64.5%) of the respondents will opt for day case surgery if offered again [Table 2]. Thirty-six (36.5%) of the respondents recommended a reduction in the waiting time for surgery as an area that needs improvement in the day case surgical practice, whereas 27.3% suggested reducing the fasting time and 18% of the parents were of the opinion that upgrading the waiting room environment would improve the quality of care [Figure 1].
| Discussion|| |
The pediatric day case surgery in the Lagos University Teaching Hospital had its debut in the 1990's and since its inception there has been a gradual increase in both the volume of patients treated on a day case basis as well as the number of procedures performed as same day surgeries. However, no study has been conducted to evaluate and audit the day case surgery unit since its inception and the parental perception of the quality of care has thus never been obtained. The outcome of such study could serve a platform upon which necessary changes could be effected in the day case surgery unit so that standards are upheld and quality of care is not sacrificed for efficiency. , The study equally sets to highlight specific problems identified by parents that need to be tackled so as to make the same day surgery acceptable to them.
In a study of the day case surgery in Ile-Ife, Nigeria, by Agbakwuru et al. where the age range of patients operated was 3 months to 97 years, patients less than 10 years accounted for 32.8% of the total cases. Patients' acceptance of the concept reportedly was 89.5%. 
In a study of parental satisfaction carried out by Erden et al. in Turkey, it was found that despite the high turnover rate of pediatric day cases, the quality of care was not compromised and there was a high parental satisfaction. Of the 100 parents interviewed over a 2 months period, 88% regarded their level of interaction with their managing doctors to be satisfactory and 64% were satisfied with the anesthesiologists.  The major source of dissatisfaction, however, was with the physical condition of the operating environment.  The highest degree of satisfaction from our study (i.e. eighty-seven (86%) of the respondents) was in obtaining information from the doctors before the operation. Seventy-seven (76.2%) of the parents were satisfied with their interaction with the anesthetist but the highest levels of dissatisfaction from our own study was with the physical condition of the waiting room (81.8%).
In another study conducted by Fadiora et al. on 102 consecutive patients, 84.3% expressed satisfaction with day case surgery, whereas 9.8% were dissatisfied. There was no mortality in this study and 70.6% of those surveyed complained of one or more complications with pain being the topmost. 
Our study, however, revealed a much lower acceptance rate than the studies by Agbakwuru et al. and Fadiora et al. with only 64.4% of our respondents opting for the day case surgery if offered again. This can be attributed to dissatisfaction with the waiting time, fasting time, and waiting room condition as well as with the nursing care. The low level of satisfaction with the nursing care, in our study, can be attributed to the fact that our day case surgery center shares the same facility with other general operations within the hospital and the overall burden of the nursing care imposed on the attending nurses at the recovery room may have translated to a much lower patient to nurse contact than anticipated by the parents. This can be adequately addressed by having a dedicated pediatric day case surgery center as against a hospital integrated one. Ghabeli et al. highlighted the role of a play therapy as a distraction tool in day case surgery. The provision of toys in a play room environment has been found to douse the fears and anxieties in children in a seemingly strange hospital environment. This was reported to have contributed to the high parental satisfaction in their study.  We believe if such a facility was existent in our center, we would have recorded a much higher parental satisfaction rating of the waiting room.
Similarly as with Fadiora's review, we also obtained a high level of dissatisfaction with the adequacy of pain control and PONV control (73.7% and 88.8%, respectively). These sharply contrast the findings of Shum et al. who obtained a mean score for parental satisfaction with postoperative pain of 4.8, for pain control, using a five-point Likert scale. The high parental rating of the postoperative pain control was ascribed to their adoption of multimodal intraoperative analgesia consisting of Nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and opioids.  We do not routinely administer NSAIDs to our patients.
| Conclusion|| |
Most parents are satisfied with pediatric day case surgery care. Some adjustments, however, need to be made on reducing the waiting and fasting time of the patients and improving both the waiting room environment and the nursing care in order to increase its acceptance.
| References|| |
Scarlett M, Crawford-Sykes A, Thomas M, Duncan ND. Paediatric day surgery: Revisiting the University Hospital of the West Indies experience. West Indian Med J 2007;56:320-5.
Brennan LJ. Modern day-case anaesthesia for children. Br J Anaesth 1999;83:91-103.
Suhonen R, Virtanen H, Heikkinen K, Johansson K, Kaljonen A, Leppänen T, et al
. Health-related quality of life of day-case surgery patients: A pre/posttest survey using the EuroQoL-5D. Qual Life Res 2008;17:169-77.
Hicklin L, Tostevin PM, Wyatt ME. Parental satisfaction with paediatric day-case ENT surgery. J Laryngol Otol 1999;113:1072-5.
Ahmad M, Zafar A, Griffin S, Ahmad S, Orakzai N, Fayyaz F. Audit of patients′ satisfaction after adult day-case surgery at Ayub Teaching Hospital, Abbottabad. J Ayub Med Coll Abbottabad 2005;17:22-5.
Rode H, Millar AJ, McCormack D, Prescott CA, O′Leary P, Cywes S. Ambulatory paediatric surgery. The development of a day-care surgical centre. S Afr Med J 1994;84:829-33.
Agbakwuru EA, Faponle AF, Adesunkanmi AR, Ogundoyin O. Practice and acceptance of day-care surgery in a semi-urban Nigerian hospital. East Afr Med J 2001;78:170-3.
Erden IA, Pamuk AG, Ocal T, Aypar U. Parental satisfaction with pediatric day case surgery. Middle East J Anesthesiol 2006;18:1113-21.
Fadiora SO, Kolawole IK, Olatoke SA, Adejunmobi MO. Day case surgery: Experience in a tertiary health institution in Nigeria. West Afr J Med 2007;26:24-7.
Ghabeli F, Moheb N, Hosseini Nasab SD. Effect of toys and preoperative visit on reducing children′s anxiety and their parents before surgery and satisfaction with the treatment process. J Caring Sci 2014;3:21-8.
Shum S, Lim J, Page T, Lamb E, Gow J, Ansermino JM, et al
. An audit of pain management following pediatric day surgery at British Columbia Children′s Hospital. Pain Res Manag 2012;17:328-34.
[Table 1], [Table 2]
|This article has been cited by|
||An analysis of safety and efficacy of day-care surgery in children in a tertiary care hospital in India
| ||Ravikesh Kumar,SubhasisRoy Choudhury,PratapSingh Yadav,Raksha Kundal,Amit Gupta,Nitin Hayaran,Rajiv Chadha |
| ||Journal of Indian Association of Pediatric Surgeons. 2021; 26(3): 148 |
|[Pubmed] | [DOI]|
||Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for A Digital Gaming Solution: A Qualitative Study (Preprint)
| ||Arja Rantala,Miia M Jansson,Otto Helve,Pekka Lahdenne,Minna Pikkarainen,Tarja Pölkki |
| ||JMIR Medical Informatics. 2020; |
|[Pubmed] | [DOI]|