Being aware of general and specific levels of satisfaction of patients or guardians with medical service is essential to establish patient-centered care and policies at medical facilities. Data related to patient satisfaction with medical facilities have been available since the 1990s. According to previous studies, satisfied patients tend to follow discharge instructions carefully at home, and patient satisfaction is closely related to the level of satisfaction with medical personnel^1,2,3,4).

A recent study showed that 31.2% of the pediatric population in Korea has visited an Emergency Department (ED)⁵⁾. However, the preparedness of EDs for pediatric patients is thought to be suboptimal. Another recent survey⁶⁾ showed that only 5% of hospitals had separate pediatric and adult EDs, and that, as of April 2010, 30% of hospitals did not have a separate pediatric area in their general ED. Accordingly, 76% of the survey respondents, who were healthcare providers in the participating hospitals, predicted that the level of satisfaction among the parents of pediatric patients would be lower than that among adult patients. The importance of being aware of patient satisfaction levels has been suggested, but parental satisfaction in Korea has been addressed only once, in a single-center study⁷⁾. Globally, studies of satisfaction with pediatric emergency care (PEC) are rare and tend to be small in size^{8,9,10,11,12)}.

The aims of this study were to examine parental satisfaction with PEC, and to investigate the factors influencing the overall satisfaction of the guardians. We administered a questionnaire to parents who had taken their ill or injured child to an ED during the previous 3 years. The anonymous survey was conducted nationwide using a web-based mailing system to determine the strong and weak points of PEC in Korea, so that the overall satisfaction level of guardians and pediatric patients can be improved.

In this nationwide, cross-sectional survey of Korean caregivers, 40.2% of the respondents answered that they were generally satisfied with PEC. This is comparable with the results of a national survey of 812 adults regarding emergency services (40.4%, the rate of satisfied respondents) conducted by the National Emergency Medical Center of Korea in 2010²⁾. When the participants were asked to rate their levels of satisfaction with eight categories of PEC, the lowest proportion of satisfied parents was obtained for 'environment of the ED'. This result can be related to the suboptimal preparedness of EDs for pediatric patients across the country. We have a small number of hospitals with a separate pediatric ED or area within the ED; consequently, children are being seen with adult patients in an adult ED area. However, the results of our univariate and multivariate analyses indicate that the "environment of the ED" plays a small role in influencing the overall satisfaction level of the parents. Factors found to be associated with the satisfaction level of the guardians included personnel factors such as "professionalism of the nurses", "attitude of and explanations provided by the doctors", and "waiting time from arrival to a major decision".

A recent study suggested that "timeliness of care", "empathy", "technical competence", "information dispensation" and "pain management" were the five most important elements in patient satisfaction with an ED¹⁴⁾. Another mail-based study of about 20,000 participants at 123 EDs in Canada showed four predictors of ED satisfaction, including "perceived waiting time to receive treatment", "courtesy of the nursing staff", "courtesy of the physicians" and "thoroughness of the physicians"¹⁾. Another study reported that patient satisfaction with a pediatric ED was impacted by "interaction with medical staff of ED", "appropriateness of provided information", and "time interval from arrival to meet doctors"¹²⁾. Other studies have produced similar results. One study conducted in Europe showed that providing resident physicians with training in communication skills resulted in improved patient satisfaction¹⁵⁾, while another study at a pediatric ED reported that the "perceived quality of the health interaction" and "interpersonal communication" were more important than "comfort or play items of waiting room"¹⁶⁾. The results of these studies are consistent with ours with regard to the emphasis on personnel and time factors, rather than the structure and quality of the facility or the environment of the ED¹⁾.

Previous studies have shown that more parents with high-acuity patients as determined by triage nurses felt satisfied with the care delivered^17,18). Our study also shows that "high acuity" of the child concerned was closely related to a high level of parental satisfaction, although the child's acuity was perceived by the parents. According to our study, mothers rather than any other relatives of the child were significantly less likely to be contented with the delivered PEC. This may represent the higher expectations of mothers for medical care.

To our knowledge, this is the first national survey of the satisfaction of Korean parents with ED services for pediatric patients. Although previous studies of ED satisfaction have been conducted in general or adult-combined EDs with a multicenter setting in multiple countries^1,2,3,4), pediatric reports of parental satisfaction are rare and usually based on small, single-center studies^{7,8,9,10,11,12)}. Our results can be used to find ways to improve parental and patient satisfaction with PEC.

Our study has some limitations. First, the survey was based on the recent experience of parents with PEC; thus, there is a possibility of "recall bias". However, anonymous web-based surveys represent a feasible method for collecting a large amount of data, and we assumed that the method would enable a favorable environment for the respondents. Second, there may be concern about "selection bias" because we identified the respondents from the listings of a commercial survey company. However, the respondents were distributed across Korea, and the proportion of older respondents (>50 years old) was substantial (11.0%) despite the web-based methodology of the study. Third, in our study, the comparison of perceived versus real length of stay was not investigated although a previous study showed that "perceived length of stay" rather than "real length of stay" was more important in determining patient satisfaction, because we depended on the experience of the participants. Therefore, the results related to time factors in our study should be interpreted carefully.

In conclusion, our survey shows that the overall satisfaction of parents in Korea with PEC is relatively low, and is closely related to personnel factors, including the "professionalism of the nurses", "attitude of and explanations provided by the doctors", and "waiting time from arrival to a major decision".