Surveys

Inpatient Satisfaction Survey

 
 
 

SURVEY INSTRUCTIONS

  • Complete this survey only if you were the patient during the hospital stay.

  • 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.

  • You are sometimes told to skip over some questions in this survey. When this happens, you will see a note that tells you which question to answer next, e.g.:

Yes
No (If “No”, go to question 1)

 
Your Care from Nurses
1. During this hospital stay how often did the nurses treat you with courtesy and respect?
2. During this hospital stay, how often did the nurses listen carefully to you?
3. During this hospital stay, how often did the nurses explain things in a way you could understand?
4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
Your Care from Doctors
5. During this hospital stay, how often did the doctors treat you with courtesy and respect?
6. During this hospital stay how often did the doctors listen carefully to you?
7. During this hospital stay, how often did the doctors explain things in a way that you could understand?
The Hospital Environment
8. During this hospital stay how often were your room and bathroom kept clean?
9. During this hospital stay, how often was the area around your room kept quiet at night?
Your Experience in this Hospital
10. During this hospital stay did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?
11. How often did you get help in getting to the bathroom or in using the bedpan as soon as you wanted?
12. During this hospital stay, did you need medicine for pain?
13. During this hospital stay, how often was your pain well controlled?
14. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
15. During this hospital stay, were you given any medicine that you had not taken before?
16. Before giving you any new medicine, how often did the hospital staff tell you what the medicine was for?
17. Before giving you any new medicine, how often did the hospital staff describe possible side effects in a way you could understand?
When You Left the Hospital
18. After you left the hospital, did you go to your own home, to someone else's home, or to another health facility?
19. During this hospital stay did doctors, nurses, or other hospital stafftalk with you about whether you would have the help you needed when you left the hospital?
20. During this hospital stay, did you get information in writing about what symptoms or health problems to look for after you left the hospital?
Overall Rating of Hospital
Please answer the following questions about your stay at Pointe Coupee General Hospital. Do not include any other hospital stays in your answers.
21. 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 stay?
22. Would you recommend this hospital to your friends and family?
About You
23. In general, how would you rate your overall health?
24. What is the highest grade or level of school that you have completed?
25. Are you of Spanish, Hispanic, or Latino origin or descent?
26. What is your race?
Please choose one or more.
27. What language do you mainly speak at home?
 

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