On two pages, discuss and compare the following study to five published articles.
Put it under the heading of discussion.
Purpose: To review client satisfaction towards ultrasound services offered to eye patients.
Methods: This cross sectional study was held at our institution in 2019. In addition to the demography, 16 questions related to staff interaction, ease of access, patient satisfaction, and quality of the techniques in the department were asked in Arabic language. Five graded Likert scale was used to collect responses. The logit score of satisfaction was correlated to demographic and other variables. Results: We interviewed 366 eye patients. The median logit of patient satisfaction score was -13.0 (IQR -16.1; -8.3) [Minimum -29.6; maximum-8.3]. There were positive in 333 (91%) and very positive was in 33 (9%) of participants. The satisfaction score by gender was not significantly different (Mann Whitney P = 0.77). The age was significantly correlated to patient satisfaction logit score (Pearson P = 0.038). The median score of subgroup of satisfaction for Interaction & communication (-5.1) was better than Technical quality of services offered (0.4), general issues of service (0.2). (P <0.001)However, it was not significantly different from the satisfaction for accessibility of services (-3.3).
Conclusions: The high level of client satisfaction for the ultrasound services provided in a tertiary eye hospital is promising. Strengthens and weakness noted affecting satisfaction of could be used to further improve the services to the eye patients.
In any service oriented industry, clients are important stakeholders . This include health services also be it private or government supported in a country as the goal of improving its quality is to satisfy end users. Patient satisfaction is an individual’s cognitive evaluation of, and emotional reaction to, his or her health-care experience. It is therefore a recommended tool for assessing the quality of different health sectors[4,5] Interestingly it has been found not related to the quality of surgical care or accreditation status of the hospital[6,7]. Patient satisfaction has been evaluated and outcomes were used to improve the quality of eye care services also in Iran. In ophthalmic services, waiting time is found to mater the most for eye consultations. Evaluation of patient satisfaction for different eye surgeries are ample in literature but study on ancillary services offered in an eye hospital are limited.
In a tertiary eye hospital apart from diagnostic and surgical care to eye patients a number of ancillary services exist in which patients have to seek assistance like laboratory, digital imaging, radiology, ultrasound, health education, etc. it is crucial that patients experience in seeking these ancillary services in eye hospital need to be reviewed and on its basis policy changes be made to improve the quality of these services. The patients of cataract, vitreoretinal diseases, orbital pathologies are referred ultrasonography unit of digital imaging department so that findings can assist eye professionals in diagnosis and determine the further mode of management.
King Khaled Eye Specialist Hospital in Riyadh is a state of art eye hospital catering to population of Saudi Arabia since 1983. It has integrated its mission and the to the VISION 2030 of Saudi Arabia. Making all efforts to improve the quality will not only satisfy the existing patients but also make them agents for promoting health tourism; a future goal of the hospital.
To the best of our knowledge, feedback of eye patients for the ancillary services offered to eye patients have not been studied.
We present patient satisfaction for ultrasonic services offered to eye patients and their determinants in a tertiary eye hospital of central Saudi Arabia.
The study was approved by the Institutional Research Board (2039-P). The tenants of Helsinki declaration were strictly abided during the research. Informed written consent was obtained from each participants. Eye patient aged 18 years and older and visiting sonography department between 1st April and 30th April 2020 were included in the study. Those critically ill brought in unconscious were excluded from the study. Those declining to participate in the study were excluded. All patients waiting for their turn for sonography procedure. Were approached for participation. They were explained that non participation will in no way affect their care and services.
There are 40,000 patients yearly who utilize the ultrasound services in our institute. We assumed that 72% of them had high satisfaction. . To achieve 95% confidence interval and 5% acceptable error margin with a clustering effect of 1.2, we need to randomly interview 370 eye patients visiting gnostic imaging department for ultrasonography. We used Open Epi software to calculate the sample size. 
One sonographic and one radiology technician were involved in the field part of the study.
The demographic information in included age and gender of the participant. We used previously-validated Patient Satisfaction Questionnaire-18 (PSQ-18)., of the 18 questions two questions were omitted to make it suitable for the situation in study site. Since all services are free of cost we did not ask satisfaction regarding cost. All precautions were taken to prevent infection spread during Covid 19 pandemic. The questionnaire was translated in Arabic language. Its validity was tested by using reverse translation method. If patient was illiterate, his care taker or field investigator assisted in explaining the questions. Of the sixteen questions related to satisfaction, two were related to satisfaction in general of services, __ questions were related to Interaction & communication, ___ questions were about Technical quality of services offered and __ were related to accessibility of ultrasonography facilities. The responses had five graded Likert scale.  The participant was free not to respond any of the question if they do not want to. Those with positive satisfaction response had logit values of -1.1 and -2.63 logit value. Those with negative satisfaction were having logit value 0.09 and 2.83 score. Neutral responses were given 0 score. The sum of all responses for each patient was carried out (overall satisfaction score’. Thus negative satisfaction score denote positive satisfaction.
The data was entered into spreadsheet of Microsoft XL. The sum of 16 satisfaction related questions logit score was our main outcome of the study. The data was then transferred into spreadsheet of Statistical Package for Social Studies (SPSS=26) (IBM, NY, USA). The total score was plotted to study distribution. If the distribution was normal, we calculated mean and standard deviation. If it was not normal, we presented as median and inter quartile range. With minimum and maximum value of score. The satisfaction score for subgroups of type of satisfaction were also calculated. The score was correlated to gender and age. The validation was carried out using nonparametric method. Mann Whitney P value was calculated to compare score by gender. A value of <0.05 was considered as statistically significant.
We interviewed 366 eye patients.. Mean age of adult Saudi eye patients participating in in our study was 49.7±16.2 years. There were 212 (57.9%) males and 154 (42.6%) females.
The median logit of patient satisfaction score was -13.0 (IQR -16.1; -8.3) [Minimum -29.6; maximum-8.3]. There were positive in 333 (91%) and very positive was in 33 (9%) of participants.
The logit of score in male participants was -13.0 (IQR -16.0; -8.5). The logit score in female was -13.0 (IQR – 17.2 ; -8.1). The satisfaction score by gender was not significantly different (Mann Whitney P = 0.77).
The age was significantly correlated to patient satisfaction logit score (Pearson P = 0.038).