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Original Research (Original Article) 


Zead Ibrahim A. Alhussain et al, 2019;3(11):957–962.

International Journal of Medicine in Developing Countries

Awareness of the Saudi population about the role of the emergency rooms

Zead Ibrahim A. Alhussain1*, Mohammed Ali A. Alghamdi2, Rana Mohamed Ahmad3, Abdullah Yahya Al dhban4, Abdulrahman Ali Alghamdi4, Naif Shalan J. Alalyani4

Correspondence to: Zead Ibrahim A. Alhussain

*Arabian Gulf University, Medical College of Arabian Gulf University, Manama, Bahrain.

Email: alhussainzead [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 19 September 2019 | Accepted: 06 October 2019


ABSTRACT

Background:

The hospital emergency department (ED) is one of the most important components of the healthcare delivery system. This study aims to investigate the public awareness of the Emergency Rooms (ERs) in Saudi Arabia, what the public knows about the provided services, and if they know the difference between the outpatient clinics and the ERs.


Methodology:

It is a cross-sectional descriptive community-based study, carried out on 977 participants from all the age groups, in different areas of Saudi Arabia, from 1 January to 31 July 2019. Data were collected by filling the pre-designed online questionnaire. We utilized the SPSS program version 16. The X2 test was used as a test of significance, and differences considered significant at p value less than 0.05.


Results:

Most of the participants (87.5%) reported that they knew the difference between the outpatient clinic and ER. The majority (68.1%) of subjects said that ERs mean rapid and unplanned medical care. Regarding evaluation of the provided services in ERs; 32.5% of the cases said it was satisfactory followed by 28.5% good, 19.8% excellent, 10.2% accepted, and 10% reported it was unsatisfactory. There were significant relationships between the awareness and age (p = 0.03) and education level (p = 0.003), but no relationship was found with the gender of the participant (p > 0.5).


Conclusion:

In the current study, most of the participants reported that they knew the difference between the outpatient clinics and ERs. There were significant relationships between the awareness and age and education level, but an insignificant relation was found with the gender of the participant.


Keywords:

Emergency department (ED), emergency rooms (ERs), awareness, knowledge, outpatient clinic, satisfaction.


Introduction

The Accident and Emergency Department (A and E) is a medical treatment facility that specializes in the acute care of patients who visit the ER without prior appointment [1]. It is the most vital entry point of patients into the healthcare facility of the hospital all around the world [2]. Emergency medicine (EM) is the medical specialty, which concerns with evaluation, management, and prevention of unanticipated illnesses and injuries [3]. EM is a relatively newly established specialty, which has spread as a specialty in developed and developing countries [4,5]. It is involved in diagnosing and treating all kinds of emergencies, which lead to overlap among the services provided by physicians of other specialties and those offered by the EM physician [6]. The general public in the U.S. has become more aware of this specialty, though early studies conducted there revealed a relative lack of knowledge of what EM physicians are, what they can and cannot do and their scope of practice [6,7].

The Emergency Department (ED) is considered the crucial link between pre-hospital and in-hospital medical care, where professional care always offered all the time to everyone in need [8]. It is a front door of a hospital where a considerable number of patients visit to access immediate treatment. By providing 24 hours' non-stop service throughout the year, it is considered the busiest department, compared to other departments available in the hospital [9]. Emergency care is one delivered in the first few hours after the onset of an acute medical condition [10]. Studies conducted in different parts of the world, irrespective of the prevailing health care system indicate that the growth in the use of EDs comes mostly from patients who come to the ED with complaints that can be treated in primary health care (PHC) centers [11]. ED visits have increased dramatically over the past two decades, often for conditions that could be treated more effectively in a lower-cost, primary care setting [12]. Over the past decade, there was an increase in the utilization of public EDs in Saudi Arabia. For example, the number of visits made to the Ministry of Health EDs rose from 9 million visits in 2000 to about 18 million visits in 2009 [13].

Studies suggest that factors associated with the frequent use of ED include socio-demographic characteristics of patients, such as their age, gender, level of education, marital status, income, and insurance coverage [14]. Medical factors include health status, type of health complaint, and the severity of illness [15]. Studies assessing public awareness of emergency medical services (EMS) have been conducted in many parts of the world. A survey of 1,534 people in the Western region of Saudi Arabia concluded that 33% of the people were unaware of the number to call, in case of a medical emergency [16].

Up to our knowledge, there are no sufficient previous studies to measure public awareness about the role of the emergency rooms (ERs) in Saudi Arabia. This information is essential to improve the public information about the ERs and improve the overall satisfaction of the community from the provided services.

So, we conducted this study to investigate the public awareness of the ERs in Saudi Arabia, their knowledge about the provided services, and if they know the difference between the outpatient clinics and ERs.


Methodology

It is a cross-sectional descriptive community-based study carried out on 977 male and female, young and adult participants from all age groups, in different areas of the Kingdom of Saudi Arabia, during the period from 1 January to 31 July 2019.

The sample size was calculated using the sample size equation: n = z2p (1–p)/e2, considering the target population more than 1,000, and study power 95%. Systematic random sampling technique was followed. Data were collected through filling the pre-designed online questionnaire, which guided us to the data of sociodemographic characteristics such as age, sex, educational status, and marital status; it also included questions about their awareness regarding the difference between the outpatient clinics and ERs, the meaning of ERs in their mind and their evaluation to the provided services in ERs.

We utilized the Statistical Package for Social Sciences, version 16 (SPSS Inc., Chicago, IL) to analyze the study data. Descriptive statistics were employed. Chi-square test was used. p-value considered as significant if less than 0.05.


Results

The majority (44.6%) of the participants aged 21–30 years, 54.1% were females, 75.6% had a university or more education, about half (49.9%) were not working, 42.4% were employed, 51.3% were singles, and 45.4% were married. There were 20.6% of the participants having health insurance, 63.2% were eligible for free treatment in special hospitals (Table 1).

Table 2 illustrates the knowledge about the ERs among the studied population. It is clear from the table that, the majority of cases, 87.5% reported that they knew the difference between the outpatient clinic and ER. Regarding the knowledge about the ER among the studied population especially what it is mean; the majority of the participants (68.1%) defined ER as a rapid and unplanned medical care, 17.3% defined it as a place where any needed health care is available, 12.2% said it as an insufficient medical care, and only 2.5% of the participants said it means availability of physician at any time for any purpose. Regarding the evaluation to the provided services in ERs; 32.5% of the cases said it was satisfactory followed by 28.5% good, 19.8% excellent, 10.2% accepted, and 10% reported it was unsatisfactory (Table 2).

Regarding the relation between the meaning of ERs and age group, sex, and educational level of the studied population, our study found that there were significant correlations with age (p = 0.03) and education level (p = 0.003), but no relation found with sex (p > 0.5) (Table 3).

According to the relation between knowing the difference between the outpatient clinic and ERs and age group, sex, and educational level of the studied population, our study reported no significant correlations with all of them (p > 0.05) (Table 4).


Discussion

The hospital ED is one of the most critical components of the healthcare delivery system. EDs worldwide are reportedly serving increasing numbers of patients who have a range of problems of variable urgency, from mild to life-threatening [17]. Nowadays, access to the ED is available for two-thirds of patients admitted to hospitals in the United States [18]. This is a cross-sectional study conducted among 977 individuals of the studied population, Saudi Arabia. The study aims to investigate the public awareness of the EMs in Saudi Arabia, what the public knows about the provided services, and if they know the difference between the outpatient clinics and ERs.

Table 1. Socio-demographic characteristics of the studied population, KSA, 2019 (N = 977).

Variable No. %
Age group
21–30 154 15.8
31–40 436 44.6
41–50 228 23.3
<21 100 10.2
>50 59 6.0
Gender
Female 529 54.1
Male 448 45.9
Educational level
Primary 16 1.6
Secondary 198 20.3
Preparatory 24 2.5
University or more 739 75.6
Marital status
Single 501 51.3
Married 444 45.4
Widow/divorced 32 3.2
Working status
Private work 39 4.0
Not working 488 49.9
Retired 36 3.7
Employed 414 42.4
Average family income/month
<5000 189 19.3
5,000–9,000 258 26.4
9,000–19,000 351 35.9
>19,000 179 18.3
Having health insurance
No 776 79.4
Yes 201 20.6
Eligible for free treatment in special hospitals
No 360 36.8
Yes 617 63.2
Type of that hospital
National guard hospital 37 3.8
Army forces hospital 195 20.0
Security forces hospital 78 8.0
Other hospitals 304 31.1

The aim of ED is to receive, triage, support, and provide urgent and immediate intervention to emergency conditions so it would lower the risks and increase the chances of better outcomes [19]. According to knowledge about the ER among the studied population especially what it is mean; the majority of the participants (68.1%) defined ER as a place with rapid and unplanned medical care, 17.3% defined it as a place where any needed health care is available, 12.2% defined it as an insufficient medical care and only 2.5% of the participants defined it as a place having availability of physician at any time for any purpose. Similar to our results, in Arar, Saudi Arabia, another study was conducted among 355 male and female patients of all the age groups attending the EDs found that 65.5% of the patients defined it as rapid and unplanned medical care, 16.9% of the patients defined it as a place where any needed health care is available, 15.8% as insufficient medical care, and 2.3% of the patients defined it as a place with availability of physician at any time for any purpose [20].

The ED offers care for both mental and physical health conditions and links patients with the most appropriate providers and care settings for presenting their conditions [21]. An inpatient is someone who’s been admitted to hospital for medical treatment. The main two ways that you could become an inpatient is through a hospital’s ERs (ERs), or through a pre-booked surgery or treatment (like if you need a knee replacement) [22]. Outpatient care, on the other hand, is medical service provided that does not require a prolonged stay at a facility. This can include routine services such as checkups or visits to clinics [23]. In the current study, the majority of cases (87.5%) reported that they knew the difference between the outpatient clinic and ER. Another study found that 89.6% of the cases knew the difference between the outpatient clinic and ER and 10.4% didn’t know the difference [20].

Evaluation of ED performance remains a challenging task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability [24]. Regarding the evaluation to the provided services in ERs, our study found that 32.5% of the cases said it was satisfactory followed by 28.5% good, 19.8% excellent, 10.2% accepted, and 10% reported it was unsatisfactory. Also, another study reported; 32.7% of the participants said that the services were excellent, 29.3% good, 17.2% excellent, 11.3% bad, and 9.6% of the participants claimed the services as acceptable [20].

Regarding the relation between the meaning of ERs and age group, sex and educational level of the studied population, our study found that there were significant correlations with age (p = 0.03) and education level (p = 0.003), but no relation found with sex (p = 0.2).

According to the relation between Knowing the difference between the outpatient clinics and ERs and age group, sex and educational level of the studied population, our study reported no significant correlations with all of them (p > 0.05).


Conclusion

In the current study, most of the participants reported that they knew the difference between the outpatient clinics and ERs. The majority of subjects defined ERs as rapid and unplanned medical care and/or availability of physician at any time for any purpose. There were significant relationships between the awareness and age and education level, but an insignificant relationship was found with the gender of the participant. So, we recommend health education to increase public awareness about the role of the ERs, and what should be expected of it, to increase the satisfaction of the community of their provided service. Also, we recommend more detailed research to be conducted on the topic.

Table 2. Knowledge about the ERs among the studied population, KSA, 2019.

Variables No. %
Do you know the difference between the outpatient clinic and ERs
No 122 12.5
Yes 855 87.5
What is the meaning of ERs in your mind?
Rapid and unplanned medical care 665 68.1
Any needed health care is available 169 17.3
Insufficient medical care 119 12.2
Availability of physician at any time for any purpose 24 2.5
What is your evaluation to the provided services in ERs
Good 278 28.5
Very good 308 31.5
Bad 98 10.0
Accepted 100 10.2
Excellent 193 19.8

Table 3. Relation between the meaning of ERs and age group, sex and educational level of the studied population, KSA, 2019.

What is the meaning of ERs in your mind? Rapid and Any needed
Variables Responses Rapid and unplanned medical care (N = 665) Any needed health care is available (N = 169) Insufficient medical care (N = 119) Availability of physician at any time for any purpose (N = 24) Total N = 977) p value
Age group <21 113 25 14 2 154 0.039
17.0% 14.8% 11.8% 8.3% 15.8%
21–30 311 65 49 11 436
46.8% 38.5% 41.2% 45.8% 44.6%
31–40 138 47 36 7 228
20.8% 27.8% 30.3% 29.2% 23.3%
41–50 61 23 14 2 100
9.2% 13.6% 11.8% 8.3% 10.2%
>50 42 9 6 2 59
6.3% 5.3% 5.0% 8.3% 6.0%
Sex Female 362 80 76 11 529 0.243
54.4% 47.3% 63.9% 45.8% 54.1%
Male 303 89 43 13 448
45.6% 52.7% 36.1% 54.2% 45.9%
Educational level Primary 5 3 5 2 16 0.003
.6% 1.2% 4.2% 8.3% 1.3%
Secondary 127 43 21 7 198
19.1% 25.4% 17.6% 29.2% 20.3%
Preparatory 15 3 6 0 24
2.3% 1.8% 5.0% 0% 2.5%
University or more 517 120 87 15 739
77.7% 71.0% 73.1% 62.5% 75.6%

Table 4. Relation between knowing the difference between the outpatient clinic and ERs and age group, sex and educational level of the studied population, KSA, 2019.

Knowing the difference between the outpatient clinic and ERs
Variable Responses No (N=122) Yes (N=855) Total (N=977) P value
Age group <21 23 131 154 0.468
18.9% 15.3% 15.8%
21-30 59 377 436
48.4% 44.1% 44.6%
31-40 21 207 228
17.2% 24.2% 23.3%
41-50 12 88 100
9.8% 10.3% 10.2%
>50 7 52 59
5.7% 6.1% 6.0%
Sex Female 67 462 529 0.467
54.9% 54.0% 54.1%
Male 55 393 448
45.1% 46.0% 45.9%
Educational level Primary 4 12 16 0.283
2.5% 1.2% 1.6%
Secondary 30 168 198
24.6% 19.6% 20.3%
Preparatory 4 20 24
3.3% 2.3% 2.5%
University or more 84 655 739
68.9% 76.6% 75.6%

List of Abbreviations

ED Emergency department
EM Emergency medicine
EMS Emergency medical services
ER Emergency Rooms
PHC Primary health care

Conflicts of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was done under the supervision of Arabian Gulf University,Manama,Bahrain, during the period from 1 January to 31 July 2019.


Author details

Zead Ibrahim A. Alhussain1, Mohammed Ali A. Alghamdi2, Rana Mohamed Ahmad3, Abdullah Yahya Al dhban4, Abdulrahman Ali Alghamdi4, Naif Shalan J. Alalyani4

  1. Arabian Gulf University, Medical College of Arabian Gulf University, Manama, Bahrain
  2. King Saud bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia
  3. Almaarefa University, Riyadh, Saudi Arabia
  4. King Khaled University Abha, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alhussain ZIA, Alghamdi MAA, Ahmed RM, Aldhban AY, Alghamdi AA, Alalyani NSJ. Awareness of the Saudi population about the role of the Emergency Rooms. IJMDC. 2019; 3(11): 957-962. doi:10.24911/IJMDC.51-1568717752


Web Style

Alhussain ZIA, Alghamdi MAA, Ahmed RM, Aldhban AY, Alghamdi AA, Alalyani NSJ. Awareness of the Saudi population about the role of the Emergency Rooms. https://www.ijmdc.com/?mno=65859 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1568717752


AMA (American Medical Association) Style

Alhussain ZIA, Alghamdi MAA, Ahmed RM, Aldhban AY, Alghamdi AA, Alalyani NSJ. Awareness of the Saudi population about the role of the Emergency Rooms. IJMDC. 2019; 3(11): 957-962. doi:10.24911/IJMDC.51-1568717752



Vancouver/ICMJE Style

Alhussain ZIA, Alghamdi MAA, Ahmed RM, Aldhban AY, Alghamdi AA, Alalyani NSJ. Awareness of the Saudi population about the role of the Emergency Rooms. IJMDC. (2019), [cited October 15, 2021]; 3(11): 957-962. doi:10.24911/IJMDC.51-1568717752



Harvard Style

Alhussain, Z. I. A., Alghamdi, . M. A. A., Ahmed, . R. M., Aldhban, . A. Y., Alghamdi, . A. A. & Alalyani, . N. S. J. (2019) Awareness of the Saudi population about the role of the Emergency Rooms. IJMDC, 3 (11), 957-962. doi:10.24911/IJMDC.51-1568717752



Turabian Style

Alhussain, Zead Ibrahim A., Mohammed Ali A. Alghamdi, Rana Mohamed Ahmed, Abdullah Yahya Aldhban, Abdulrahman Ali Alghamdi, and Naif Shalan J. Alalyani. 2019. Awareness of the Saudi population about the role of the Emergency Rooms. International Journal of Medicine in Developing Countries, 3 (11), 957-962. doi:10.24911/IJMDC.51-1568717752



Chicago Style

Alhussain, Zead Ibrahim A., Mohammed Ali A. Alghamdi, Rana Mohamed Ahmed, Abdullah Yahya Aldhban, Abdulrahman Ali Alghamdi, and Naif Shalan J. Alalyani. "Awareness of the Saudi population about the role of the Emergency Rooms." International Journal of Medicine in Developing Countries 3 (2019), 957-962. doi:10.24911/IJMDC.51-1568717752



MLA (The Modern Language Association) Style

Alhussain, Zead Ibrahim A., Mohammed Ali A. Alghamdi, Rana Mohamed Ahmed, Abdullah Yahya Aldhban, Abdulrahman Ali Alghamdi, and Naif Shalan J. Alalyani. "Awareness of the Saudi population about the role of the Emergency Rooms." International Journal of Medicine in Developing Countries 3.11 (2019), 957-962. Print. doi:10.24911/IJMDC.51-1568717752



APA (American Psychological Association) Style

Alhussain, Z. I. A., Alghamdi, . M. A. A., Ahmed, . R. M., Aldhban, . A. Y., Alghamdi, . A. A. & Alalyani, . N. S. J. (2019) Awareness of the Saudi population about the role of the Emergency Rooms. International Journal of Medicine in Developing Countries, 3 (11), 957-962. doi:10.24911/IJMDC.51-1568717752