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Tell us about your stay at your local Hospital
Tell us about your stay at your local Hospital
Your name
Email address
Name of the Hospital you Grading
What Sevice Area are you grading ? (Choose one)
ER
ICU
CCU
Intermidetae Care/Step Down Unit
Cath Lab
OR
Ambulatory Surgery Center
Outpatient Services
PACU (Post Anesthesia Recovery Unit)- Day Surgery
Radiology
MED/SURG Unit
GI Lab/Endoscopy
Labor & Delivery
Wound Center
Pediatric ICU
Pediatric Step Down Unit
Pediatric MED/SURG Unit
Other
If not listed, Type in what Service Area are you grading
During this hospital stay, how often did nurses treat you with courtesy and respect ?
Never
Sometimes
Usually
Always
During this hospital stay, how often did nurses listen carefully to you ?
Never
Sometimes
Usually
Always
During this hospital stay, how often did nurses explain things in a way you could understand ?
Never
Sometimes
Usually
Always
During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it ?
Never
Sometimes
Usually
Always
How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted ?
Never
Sometimes
Usually
Always
During this hospital stay, how often was your pain well controlled ?
Never
Sometimes
Usually
Always
During this hospital stay, how often did the hospital staff do everything they could to help you with your pain ?
Never
Sometimes
Usually
Always
Before giving you any new medicine, how often did hospital staff tell you what the medicine was for ?
Never
Sometimes
Usually
Always
Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand ?
Never
Sometimes
Usually
Always
When I left the hospital, I clearly understood the purpose for taking each of my medications.
Strongly disagree
Disagree
Agree
Strongly agree
I was not given any medication when I left the hospital
Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay ?
1
2
3
4
5
6
7
8
9
10
Would you recommend this hospital to your friends and family ?
Definitely no
Probably no
Probably yes
Definitely yes
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