The impact of patient perspective on the pediatric endoscopy as part of the Italian EndoPed Quality Improvement Initiative

OBJECTIVE: Patient satisfaction (PS) is an important healthcare outcome and should be an integral part of quality improvement agendas. Between 2019 and 2021, the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition, Endoscopy Interest Group conducted a nationwide quality assessment survey, EndoPed. One of the study's aims was to identify areas for improvement based on the results of a PS questionnaire. METHODS: The smartphone app-based, prospective survey involved 24 Italian pediatric endoscopy centers. Procedure details and quality standards were recorded. The modified Group Health Association of America-9 (GHAA-9m) satisfaction questionnaire consisted of 7 Likert-scale questions that explored waiting times, communication, and staff evaluation. Two additional closed questions investigated the will to confirm the endoscopist and the facility. Dissatisfaction was defined with the arbitrary cut-off of < 7/10. RESULTS: Questionnaire results were available for 1974 (55%) procedures. The questionnaire's internal consistency was good (Cronbach's α 0.86). Overall satisfaction was high. Shorter operator experience (odds ratio [OR] 4 [95% confidence interval [CI] 1.6 to -10.3]; p < 0.003), prolonged waiting time (OR 2.7 [95%CI 1.6-4.5]; p < 0.000), prolonged procedure duration (OR 2.9 [95% CI 1.8-4.7]; p < 0.000) and conscious sedation (OR 5 [95% CI 3-6.2]; p < 0.000) were confirmed in a multivariate model to be associated to lower satisfaction rates. CONCLUSIONS: Through a standardized methodology, the PS questionnaire is a valuable tool for clinical quality assessment. PS highlight improvement fields different from those identified by quality standards and items, adding elements for an exhaustive quality evaluation. Interventions derived from PS analysis could help to improve pediatric endoscopy.