ADULT 18yrs and Over
Patient Experience Survey - Anaesthesia

OzMed Trust ADULT Perioperative period patient experience survey - Anaesthesia

A voluntary, quality improvement activity

Thank you for agreeing to be a part of this process. The administrator, on behalf of anaesthetist, who has sent you this form is participating in this voluntary activity as part of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) Continuing Professional Development (CPD) program.

The purpose of the patient experience survey is to help the anaesthetist improve their service and we would like to invite you to complete this survey.

We greatly appreciate your time to participate and would like to assure you that your answers remain confidential and all feedback is anonymous.

Please contact OzMed Trust Anaesthetic should you need assistance or require further information:

Phone: 02 4480 6464 or 1800 258 531 or Email: admin@ozmedtrust.com.au

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* 1. Today's Date:

Today's Date

Date

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* 2. Date of Surgery:

Date of Surgery

Date

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* 3. Name of your Anaesthetist:

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* 4. Please tell us your gender:

Female

Male

Non Binary

Prefer not to say

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* 5. Age:

18-24

25-34

35-44

45-54

55-64

65-74

75 or older

For the questions below, please answer Yes or No and where indicated choose a rating of 1 to 5, where: 1 is Poor and 5 is Excellent

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* 6. Did you have pain before surgery?

Yes

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* 7. Was your anaesthetist involved in managing your pain before surgery?

Yes

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* 8. If Yes, how well do you think we managed your pain?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Are there any comments you would like to make?

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* 9. Did you feel like you had time to ask your anaesthetist questions before your surgery?

Yes

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* 10. If Yes, how well were those questions answered?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Are there any comments you would like to make?

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* 11. Did you understand the information about your anaesthetic that was given to you before your surgery?

Yes

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* 12. If Yes, how useful did you find the information?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Are there any comments you would like to make?

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* 13. Did you feel like your anaesthetist listened to you?

Yes

Are there any comments you would like to make?

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* 14. Did you feel rushed?

Yes

Are there any comments you would like to make?

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* 15. Did you feel scared or anxious before your surgery?

Yes

Other (please specify)

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* 16. If Yes, how well did your anaesthetist manage your fear and anxiety?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Comments

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* 17. Did your anaesthetist explain to you how you might feel after the surgery?

Yes

Comments

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* 18. Did you feel nauseated and/or vomit immediately after the surgery?

Yes

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* 19. If Yes, how well was it treated?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

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* 20. Were you in pain after the operation?

Yes

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* 21. If Yes, how effective was your pain treatment?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Comments

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* 22. Were you cold or shivering after the surgery?

Yes

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* 23. If Yes, how well was it managed?

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

1. Poor

2. Fair

3. Good

4. Very Good

5. Excellent

N/A

Comments

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* 1. Today's Date:

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* 2. Date of Surgery:

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* 3. Name of your Anaesthetist:

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* 4. Please tell us your gender:

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* 5. Age:

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* 6. Did you have pain before surgery?

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* 7. Was your anaesthetist involved in managing your pain before surgery?

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* 8. If Yes, how well do you think we managed your pain?

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* 9. Did you feel like you had time to ask your anaesthetist questions before your surgery?

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* 10. If Yes, how well were those questions answered?

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* 11. Did you understand the information about your anaesthetic that was given to you before your surgery?

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* 12. If Yes, how useful did you find the information?

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* 13. Did you feel like your anaesthetist listened to you?

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* 14. Did you feel rushed?

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* 15. Did you feel scared or anxious before your surgery?

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* 16. If Yes, how well did your anaesthetist manage your fear and anxiety?

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* 17. Did your anaesthetist explain to you how you might feel after the surgery?

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* 18. Did you feel nauseated and/or vomit immediately after the surgery?

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* 19. If Yes, how well was it treated?

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* 20. Were you in pain after the operation?

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* 21. If Yes, how effective was your pain treatment?

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* 22. Were you cold or shivering after the surgery?

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* 23. If Yes, how well was it managed?

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* 24. If you had a positive experience, please tell us about it.

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* 25. If you had a negative experience, please tell us about it.

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* 26. Do you have any suggestions about how your care could have been improved?