PONE-D-20-06847

Assessment Patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia

PLOS ONE

Dear Dr. Molalign,

Thank you for submitting your manuscript to PLOS ONE; I sincerely apologise for the unusually delayed review timeframe. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Your study has been assessed by four reviewers, whose comments are appended below. Although the reviewers to find the study to be of interest, they raise several points that must be addressed before further consideration of this work. Among the concerns are whether the questionnaire was pretested or validated, whether the study received approval from a dedicated research ethics committee or institutional review board, a discussion of the strengths and limitations of this work, and a comparison of these findings to similar studies in other regions. In addition, the reviewers raise several concerns about the statistical analyses that must be addressed.

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Emily Chenette

Deputy Editor-in-Chief

PLOS ONE

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2.Please explain how the BEDPSS questionnaire was adopted and modified for this work. In addition, please state how the questionnaire was pre-tested and validated. If this did not occur, please include the rationale for not pre-testing or validating the questionnaire.

We note that ethics approval was granted by Mekelle University, College of Health Sciences, School of Nursing. It is not clear if this group is duly qualified to provide ethics approval for human subjects research. Could you please clarify whether the study was approved by an Institutional Review Board or Research Ethics Committee, include the date on which the study was approved and provide the approval or permit number that was issued?

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4.We note that Table 3, Table 5 and Additional File 1  in your submission (which seem to reproduce the "Brief Emergency Department Patient Satisfaction Scale questionnaire" (http://www.journals.sbmu.ac.ir/AAEM/index.php/AAEM/article/view/278/580) contain copyrighted information. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: N/A

Reviewer #4: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: manuscript technically sound was good, and data supported the conclusions. Additionally the statistical analysis been performed appropriately. The Tool need only to be clarified , the validity and reliability if did it by author or it was standardize and valid by the established author and when.

Reviewer #2: I have read this paper with great interest. The study assessed the degree of patient satisfaction regarding the Emergency Medical Services. The authors found the total patient satisfaction score towards emergency medical care to be good, as they also determined that the patient's waiting time is considered to be significantly associated with patient satisfaction level. Other research studies also identified waiting time in the clinic as an important indicator of patient satisfaction. I did not identify any of major or minor concern. In conclusion, the research study has identified some important elements that are imperative to form the model of Emergency Medical Services.

Reviewer #3: The study seems interesting in the context of northern Ethiopia and it can provide insights to the policy makers who are involved in quality of care.

My comments to the manuscript are as such.

1. Most of the sentences are in passive voice; I would better prefer to use active voice especially in method section. like:

"Every day, 200 patients visit the emergency department of the hospital" instead of "Daily it is visited by up to 200 patients."

2. Why this sentence is in sample size calculation and sampling method.? I am quite confused about it. "Busy work hours, different providers, day of the week and the type of client complaint were considered to affect satisfaction level."

3. Do avoid using didn't : instead use did not ( finding section)

4. Do use past tense consistently in the finding section; you are vacillating from past tense to present tense.

5. I think interpretation of odds ratio is not appropriate: It should be like this: "The odds of patient who arrived during the morning time of the day, reporting to be satisfied were 4.8 times compared to their counterparts arriving at night ( AOR=4.8, 95% CI: 2.08, 11.4)." Do revisit interpretation of odds ratio minutely.

6. You calculated Adjusted Odds ratio, but you did not mention what are the independent variables you adjusted for? Do mention clearly about it.

7. I think it would be better to summarize your main finding in the first paragraph of the discussion section and then start to compare your findings with other studies.

8. What might be the reason of variation in mean waiting time between your study and Iran's study?

9. "This difference might be due to the difference in the tool used to measure patient satisfaction, difference in clinical characteristics (medical condition on arrival) of the patients and other different factors." In this sentence, other different factors means what, like?

10. It would be better to discuss why patient visiting in morning time were more satisfied comparing with other studies.

11. Why the study finding is contrary to the finding of study in Morroco in terms of educational status, as a predictor of patient satisfaction?

Reviewer #4: The Authors propose the hospital-based study to assess patient satisfaction towards emergency medical care and its determinants in Northern Ethiopia. The study designs and methods used are basically appropriate, and the interpretations of the results are reasonable. However, there are several areas from statistical and practical viewpoints where the manuscript needs to be strengthened.

1. Please indicate the response rate of this study.

2.A statement detailing including the reference number where appropriate of ethics committee, should appear in the manuscript.

3.How are the reliability and validity of the questionnaire.

4.Tables should also appropriately labeled to show the baseline results between respondents and non-respondents.

5. How the variables are selected in the logistic regression in Table 4? Please also show the goodness-of-fit results.

6.Please consider the comparison with the other epidemiological studies in other areas using table so make clear the significance of this study.

7.What is the originality and strengths of this study? How physicians or policy makers can deliberate with subjects based on the key findings of this paper?

8. Please make sure whether formats are described of references according to the instructions for authors.

Totally, I would like to congratulate the authors for the enthusiasm invested in this study. However, the manuscript does not reach the level of quality required for publication as original article without major revision in PLOS ONE.

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Reviewer #1: Yes: Dr. Noha Mohamed Ibrahim Rashed

Reviewer #2: Yes: Tatjana Kitić Jaklič

Reviewer #3: No

Reviewer #4: Yes: Tao-Hsin Tung

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Attachments

Attachment

Submitted filename: Reviewer comments PONE-D-20-06847.docx

Assessment Patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia

PONE-D-20-06847R1

Dear Dr. molalign,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Tao-Hsin Tung, PhD

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

I am pleased to accept the revised version now.

Reviewers' comments: