Emergency Department Survey

1. Was the registration process easy to complete?

Never

Sometimes

Usually

Always

2. Was the manner of the person who registered you courteous, respectful, and sensitive?

Never

Sometimes

Usually

Always

3. Was the waiting time before you were called to an Emergency Department room appropriate?

Never

Sometimes

Usually

Always

4. Was the manner of the nursing staff courteous, respectful, and sensitive?

Never

Sometimes

Usually

Always

5. Did the nursing staff attend to your needs in a timely manner?

Never

Sometimes

Usually

Always

6. Regarding the technical skills of the nursing staff, were they thorough, careful, and competent?

Never

Sometimes

Usually

Always

7. Did the nursing staff keep you adequately informed and answer your questions?

Never

Sometimes

Usually

Always

8. Was your privacy respected?

Never

Sometimes

Usually

Always

9. Was the manner of the Emergency Department Physician courteous, respectful, and sensitive?

Never

Sometimes

Usually

Always

10. Did the physician keep you adequately informed and answer your questions?

Never

Sometimes

Usually

Always

11. Was the staff thorough, careful, and competent?

Never

Sometimes

Usually

Always

12. Did the physician spend adequate time with you?

Never

Sometimes

Usually

Always

13. Was the area clean and free of clutter?

Never

Sometimes

Usually

Always

14. Was the equipment in working order?

Never

Sometimes

Usually

Always

15. Was the noise level in the area kept to a minimum?

Never

Sometimes

Usually

Always

16. Was the room temperature comfortable?

Never

Sometimes

Usually

Always

17. Did the staff explain the education and discharge instructions in a way you could understand?

Never

Sometimes

Usually

Always

18. Were the follow up care instructions complete?

Never

Sometimes

Usually

Always

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?

0

1

2

3

4

5

6

7

8

9

10

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

Definitely no

Probably no

Probably yes

Definitely yes

21. In general, how would you rate your overall health?

Excellent

Very Good

Good

Fair

Poor

22. What is the highest grade or level of school that you have completed?

8th grade or less

Some high school, but did not graduate

High school graduate or GED

Some college or 2-year degree

4-year college graduate

More than 4-year college degree

23. Are you of Spanish, Hispanic, or Latino origin or descent?

No, not Spanish/Hispanic/Latino

Yes, Puerto Rican

Yes, Mexican/Mexican American/Chicano

Yes, Cuban

Yes, other Spanish/Hispanic/Latino

24. What is your race?

Please choose one or more.

Caucasian

African-American

Asian

Native American or other Pacific Islander

American Indian or Alaska Native

25. What language do you mainly speak at home?

English

Spanish

Chinese

Russian

Vietnamese

Other (Please answer question 26)