Pediatric Emergency Medicine Fellow University of Calgary Calgary, Alberta, Canada
Background: Poor emergency department (ED) experiences for families negatively impact their real-time and future healthcare interactions and use. Understanding children’s perspectives of their ED experiences is essential to improving ED care. Objective: Our primary objective was to describe children’s perspectives on their perceived emotional and communication needs and satisfaction during their ED visit. Our secondary objective was to compare caregivers versus children’s perspectives. Design/Methods: 514 children over age 7 years and their caregivers presenting to 10 Canadian pediatric EDs completed a cross-sectional survey using published survey development guidelines and input from a parent advisory group. Families were enrolled over 1 week per season (total 4 weeks) with staggered start dates from 2018-2020. Results: Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) of children reported adequate privacy during conversations and 78.3% (395/504) during exams. 90% (112/402) of caregivers felt that their child’s privacy was respected, but there was poor agreement between children and caregivers concerning privacy during exams (Kappa 0.11 +/- SE 0.03). 69.5% (348/501) of children understood their diagnosis; 89.4% (355/397) the rationale for tests; and 67.2% (338/503) their treatment. 90.9% (457/503) of children felt well taken care of by nurses, and 90.8% (444/489) by doctors; 94.8% (475/501) of children were happy with their overall ED visit. Predictors of a child better understanding their diagnosis included older age (OR 1.08 [1.01, 1.16]), doctors talking directly to them (OR 2.21 [1.15, 4.28]), and having questions and worries addressed (OR 2.51 [1.26, 5.01]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) and less anxiety at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) were associated with children better understanding their treatment. Predictors of a caregiver’s perception of their child’s needs being met included their own needs being met (OR 23.76 [15.02, 37.59]), and adequate pain management (OR 6.51 [4.20, 10.11]).
Conclusion(s): Almost all children were happy with their ED visit, but nearly a third did not understand their diagnosis or management. Children’s reported satisfaction should not be mistaken for understanding their medical care. Further, children’s privacy needs are often underestimated and caregiver satisfaction is most associated with having their own needs being met, highlighting the complex relationship and differences between child and caregiver experiences.
