Going to the Emergency Department

Question Title

* 1. Thinking about this visit, what was the main reason you came?

Question Title

* 2. For this visit, did you come in an ambulance?

Question Title

* 3. When you first arrived, how long was it before someone talked to you about the reason for your visit?

During this Emergency Department Visit

Question Title

* 4. During this visit, did you receive care within 30 minutes of arrival?

Question Title

* 5. During this visit, did the doctors or nurses ask about all the medications you were taking?

Question Title

* 6. During this visit, were you given any medication?

Question Title

* 7. Before giving you medicine, did the doctors or nurses tell you what the medication was for?

Question Title

* 8. Before giving you medicine, did the doctors or nurses describe possible side effects to you in a way you could understand?

Question Title

* 9. During this visit, did you have a blood test, x-ray, or any other test?

Question Title

* 10. During this visit, did doctors or nurses give you as much information as you wanted about the results of those test?

People who took care of you during this visit
Please answer the following questions about the people who took care of you during this visit.

Question Title

* 11. During this visit, how often did the nurses treat you with courtesy and respect?

Question Title

* 12. During this visit, how often did nurses listen carefully to you?

Question Title

* 13. During this visit, how often did nurses explain things in a way you could understand?

Question Title

* 14. During this visit, how often did doctors treat you with courtesy and respect?

Question Title

* 15. During this visit, how often did doctors listen carefully to you?

Question Title

* 16. During this visit, how often did doctors explain things in a way you could understand?

Leaving the Emergency Department

Question Title

* 17. Before you left, did a doctor or nurse tell you that you should take any medication at home?

Question Title

* 18. Before you left, did a doctor or nurse tell you what the medication was for?

Question Title

* 19. Before you left, did a doctor, nurse, or other staff member talk with you about follow-up care?

Question Title

* 20. Did you need information about how to establish follow-up care?

Question Title

* 21. Did a doctor, nurse, or other staff member give you information about how to establish follow-up care?

Question Title

* 22. Before you left, did a doctor, nurse, or other staff member give you information about what symptoms or health problems to look out for at home?

Overall experience
Please answer the following questions about your visit. Do not include any other visits in your answers.

Question Title

* 23. Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care doing this visit?

Question Title

* 24. How likely are you to recommend this ED to your family and friends?

Your health care

Question Title

* 25. In the last 6 months, how many times have you visited any ED to get care for yourself? Please include the visit you have been answering questions about in this survey.

Question Title

* 26. Not counting the ED, is there a doctor's office, clinic, or other place you usually go if you need a check-up, want advice about a health problem, or get sick or hurt?

About you

Question Title

* 27. In general, how would you rate your overall health?

Question Title

* 28. Date of visit (optional)

Date

Question Title

* 29. Who is completing the survey?

Question Title

* 30. Contact information (optional)

Question Title

* 31. Other comments.

Thank you for taking the time to complete our survey. Your suggestions are important to us as we continually strive to provide exceptional patient-care and services to those we serve.

If you have additional information or concerns please feel free to contact:

Director of Emergency Department

816-629-2628

T