Day Surgery Patient and Family Experience Survey
1.
Who is completing this survey?
Patient
Family Member/Caregiver
2.
Your Day Surgery visit was to which area?
Endoscopy
Day Surgery
3.
Did the health professionals treating and examining you introduce themselves?
Yes, all of the staff introduced themselves
Some of the staff introduced themselves
Very few or none of the staff introduced themselves
Don't know/Can't remember
4.
Before your procedure, did a health professional explain what would happen to you, in a way you could understand?
Definitely
For the most part
Somewhat
Not at all
Don't know/Can't remember
I did not want an explanation
5.
Before your procedure, did your doctor or anyone from the hospital give you easy to understand instructions about getting ready for your procedure?
Definitely
For the most part
Somewhat
Not at all
Don't know/Can't remember
6.
If you had to wait, were you told why?
Yes
No, but I would have liked a reason
No, but I did not mind
Don't know/Can't remember
I did not have to wait
7.
If you had any worries or fears about your condition or treatment, did a surgeon talk with you about them?
Definitely
For the most part
Somewhat
Not at all
I did not have worries or fears
8.
If you had questions to ask the anaesthesiologist, did you get answers that you could understand?
Definitely
For the most part
Somewhat
Not at all
I did not need to ask
I did not have an opportunity to ask
9.
How much information about your condition or treatment was given to your family, caregiver or someone close to you?
Not enough
Right amount
Too much
No family, caregiver or friends were involved
They didn't want or need information
I didn't want them to have any information
Don't know/Can't say
10.
How often, during your most recent day surgery experience, were you
involved as much as you wanted to be
in decisions about your care and treatment?
Always
Usually
Sometimes
Never
11.
Before you left the hospital, were you told what would happen next (for example, did you need another appointment, did you need to see your family doctor)?
Definitely
For the most part
Somewhat
Not at all
Don't know/can't remember
12.
Did you receive information about what
symptoms or health problems
regarding your illness or procedure to watch for at home?
Definitely
For the most part
Somewhat
Not at all
I did not need this type of information
13.
Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?
Definitely
For the most part
Somewhat
Not at all
14.
Overall, did you feel you were treated with respect and dignity while you were at the hospital?
Definitely
For the most part
Somewhat
Not at all
15.
Thinking about your experience related to this day surgery visit, to what extent did you experience smooth transitions between the hospital and other locations or health professionals?
Always
Usually
Sometimes
Never
Not applicable
16.
Overall...(Please pick a number)
0 I had a very poor experience
1
2
3
4
5
6
7
8
9
10 I had a very good experience
17.
What else would you like to share about your visit to Day Surgery?
18.
Is there a staff member or group that you would like to recognize for providing exceptional care or service?
If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.
