Emergency Department Patient and Family Experience Survey
1.
Who is completing this survey?
Patient
Family Member/Caregiver
2.
Your experience was at which Huron Health System Facility?
Alexandra Marine and General Hospital (AMGH - Goderich)
South Huron Hospital (SHH - Exeter)
3.
If you had a long 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 a long wait
4.
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
5.
How often did care providers treat you with courtesy and respect?
Never
Sometimes
Usually
Always
6.
How often did care providers explain things in a way you could understand?
Never
Sometimes
Usually
Always
7.
Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?
Never
Sometimes
Usually
Always
Don't know/Not sure
8.
Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit?
Never
Sometimes
Usually
Always
Not applicable
9.
Did the care providers do everything they could do to ease your discomfort or symptoms?
No
Yes, somewhat
Yes, mostly
Yes
Not applicable
10.
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?
Not at all
Partly
Quite a bit
Completely
11.
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
12.
What else would you like to say about this emergency department experience?
(Please do not include any names, contact information, or identifying information)
13.
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.
