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Questionnaire template

Hospital Inpatient Experience

Measures recently discharged inpatients' experience of admission, ward care, discharge and willingness to recommend.

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Questions in this template

Being Admitted

  1. Thank you for telling us about your recent stay in hospital. Your answers are confidential and help us improve care for every patient.

  2. After you arrived, how long was it before your admission was started?

    Choose one:

    • Straight away
    • Less than 15 minutes
    • 15 to 30 minutes
    • 30 to 60 minutes
    • More than an hour

  3. How satisfied were you with each part of your admission?

    • How quickly it was handled
    • How staff communicated with you
    • How comfortable the waiting area was

    For each row: choose one:

    • Very dissatisfied
    • Dissatisfied
    • Neutral
    • Satisfied
    • Very satisfied

  4. How important is each of these to you when being admitted?

    • How quickly it was handled
    • How staff communicated with you
    • How comfortable the waiting area was

    For each row: choose one:

    • Not at all important
    • Slightly important
    • Moderately important
    • Very important
    • Extremely important

Your Care on the Ward

  1. How satisfied were you with how clean your room and the hospital were?

    Choose one:

    • Very dissatisfied
    • Somewhat dissatisfied
    • Neutral
    • Somewhat satisfied
    • Very satisfied

  2. Which parts of your care on the ward did you especially value? Select all that apply.

    Choose any that apply:

    • Medicines given on time
    • Staff available when needed
    • Food
    • Medical oversight
    • Cleanliness
    • None of these

  3. How often did staff explain your condition and treatment in a way you could understand?

    Choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Always

Leaving Hospital

  1. Before you went home, was each of these explained to you?

    • How to take your medicines
    • Follow-up care and appointments
    • What to do and avoid while recovering
    • Whom to contact in an emergency

    For each row: choose one:

    • Yes, fully
    • Partly
    • No

  2. On a scale from 1 (very poor) to 10 (excellent), how would you rate each part of your discharge?

    • How quickly it was completed
    • How clear the information was
    • How well staff answered your questions

    For each row: choose one:

    • 1 - Very poor
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10 - Excellent

Overall

  1. What changes would most improve the experience of patients in our hospital? (optional)

    Open answer

  2. Would you recommend this hospital to your friends and family?

    Choose one:

    • Yes
    • No
    • Not sure