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PAEDIATRIC (CHILD) Under 18yrs
Patient/Parent Satisfaction Survey - Anaesthesia

OzMed Trust PAEDIATRIC (CHILD) Patient/Parent Satisfaction Survey - Anaesthesia

Thank you for agreeing to be a part of this process. The administrator, on behalf of anaesthetist, who has given you this form is participating in this voluntary activity as part of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) Continuing Professional Development (CPD) program.
The purpose of the paediatric patient/parent satisfaction survey is to help the anaesthetist improve their service and we would like to invite you to complete this survey on behalf of your child. We greatly appreciate your time to participate and would like to assure you that your answers remain confidential and all feedback is anonymous.
Please contact OzMed Trust Anaesthetic should you need assistance or require further information:
Phone: 02 4480 6464 or 1800 258 531 or Email: admin@ozmedtrust.com.au
Today's Date:(Required.)
Today's Date
Date of Surgery:(Required.)
Date of Surgery
Name of your Anaesthetist:(Required.)
Gender of Child:
Age:(Required.)
For the questions below, please answer Yes or No and where indicated choose a rating of 1 to 5, where: 1 is Poor and 5 is Excellent. Please tick the appropriate box for each question.

Please rate your anaesthetist for the following behaviours:
COMMUNICATION BETWEEN ANAESTHETIST AND PARENT/GUARDIAN
The anaesthetist listened carefully to you as the parent/guardian(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
COMMUNICATION BETWEEN ANAESTHETIST AND PARENT/GUARDIAN
The anaesthetist explained things to you in a way that was easy to understand.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
COMMUNICATION BETWEEN ANAESTHETIST AND PARENT/GUARDIAN
The anaesthetist treated you with courtesy and respect.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
COMMUNICATION BETWEEN ANAESTHETIST AND CHILD
The anaesthetist listened carefully to your child.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
COMMUNICATION BETWEEN ANAESTHETIST AND CHILD
The anaesthetist talked and acted in a way that was appropriate for your child’s age.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
COMMUNICATION BETWEEN ANAESTHETIST AND CHILD
The anaesthetist explained things to your child in a way that was easy for them to understand. 

(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
COMMUNICATION BETWEEN ANAESTHETIST AND CHILD
The anaesthetist encouraged your child to ask questions.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
The anaesthetist involved your teenager in discussion of their care.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
The anaesthetist took effort to ensure privacy when talking with you and your child.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
Was your child anxious before surgery? 
(Required.)
The anaesthetist’s effort to minimise your child’s anxiety or fear.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
Did your child have pain after surgery?(Required.)
If the answer was YES in the previous question: Management of your child’s pain after surgery.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
Did your child have nausea or vomiting after surgery? 
(Required.)
If the answer was YES in the previous question: Management of your child’s nausea and vomiting after surgery.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
If there was a problem during anaesthesia, did the anaesthetist inform you personally?(Required.)
Information from the anaesthetist about what to expect and how to care for your child after surgery.(Required.)
1. Poor
2. Fair
3. Good
4. Very Good
5. Excellent
N/A
Please tell us if you had any positive or negative experience.
Please tell us how the care of your child could have been improved.
If your child were to have another anaesthetic, would you be happy to have the same anaesthetist? 

(Required.)
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