Emergency Department Survey



  • Complete this survey only if you received services in the Emergency Department.

  • All surveys are anonymous so there is no need to attach your name.

  • Answer all of the questions by selecting the button to the left of your answer.

1. Was the registration process easy to complete?
2. Was the manner of the person who registered you courteous, respectful, and sensitive?
3. Was the waiting time before you were called to an Emergency Department room appropriate?
Nursing Staff
4. Was the manner of the nursing staff courteous, respectful, and sensitive?
5. Did the nursing staff attend to your needs in a timely manner?
6. Regarding the technical skills of the nursing staff, were they thorough, careful, and competent?
7. Did the nursing staff keep you adequately informed and answer your questions?
8. Was your privacy respected?
9. Was the manner of the Emergency Department Physician courteous, respectful, and sensitive?
10. Did the physician keep you adequately informed and answer your questions?
11. Was the staff thorough, careful, and competent?
12. Did the physician spend adequate time with you?
13. Was the area clean and free of clutter?
14. Was the equipment in working order?
15. Was the noise level in the area kept to a minimum?
16. Was the room temperature comfortable?
17. Did the staff explain the education and discharge instructions in a way you could understand?
18. Were the follow up care instructions complete?
Overall Rating of Hospital
Please answer the following questions about this visit to Pointe Coupee General Hospital. Do not include any other hospital visits in your answers.
19. Using any number 0 to 10, where 0 is the worst hospital possible and 10 the best hospital possible, what number would you use to rate this hospital during your visit?
20. Would you recommend this hospital to your friends and family?
About You
21. In general, how would you rate your overall health?
22. What is the highest grade or level of school that you have completed?
23. Are you of Spanish, Hispanic, or Latino origin or descent?
24. What is your race?
Please choose one or more.
25. What language do you mainly speak at home?

Source: HCAHPS Online
Centers for Medicare and Medicaid Services
Baltimore, MD
June 26, 2011