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* 1. Please identify from which NOSH site you accessed emergency services

Going to the emergency department

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* 2. Thinking about this visit, what was the main reason why you went to the emergency department?

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* 3. For this visit, did you go to the emergency department in an ambulance?

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* 4. When you first arrived at the emergency department, how long was it before someone talked to you about the reason why you were there?

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* 5. Using any number of 0 to 10, where 0 is not at all important and 10 is extremely important, when you first arrived at the emergency department, how important was it for you to get care right away?

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i We adjusted the number you entered based on the slider’s scale.
During you emergency department visit

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* 6. During this emergency department visit, did you get care within 1 hour of getting to the emergency department?

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* 7. During this emergency department visit, did the doctors or nurses ask about all of the medicines you were taking?

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* 8. During this emergency department visit, were you given any medicine that you had not taken before?

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* 9. Before giving you any new medicine, did the doctors or nurses tell you what the medicine was for?

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* 10. Before giving you any new medicine, did the doctors or nurses describe possible side effects to you in a way you understand?

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* 11. During this emergency department visit did you have any pain?

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* 12. During this emergency department visit, did the doctors and nurses try to help reduce your pain?

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* 13. During this emergency department visit, did you get medicine for pain?

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* 14. Before giving you pain medicine, did the doctors and nurses describe possible side effects in a way you could understand?

People who took care of you

Please answer the following questions about the people who took care of you during your emergency department visit.

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* 15. During this emergency department visit, how often did nurses treat you with courtesy and respect?

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* 16. During this emergency department visit, how often did nurses listen carefully to you?

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* 17. During this emergency department visit, how often did nurses explain things in a way you could understand?

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* 18. During this emergency department visit, did nurses spend enough time with you?

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* 19. During this emergency department visit, how often did doctors treat you with courtesy and respect?

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* 20. During this emergency department visit, how often did the doctors listen carefully to you?

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* 21. During this emergency department visit, how often did doctors explain things in a way you could understand?

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* 22. During this emergency department visit, did doctors spend enough time with you?

Leaving the emergency department

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* 23. Before you left the emergency department, did you understand what your main health problem was?

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* 24. Before you left the emergency department, did you understand what symptoms or health problems to look out for when you left the emergency department?

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* 25. Before you left the emergency department, did a doctor or nurse tell you that you should take any new medicines that you had not taken before?

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* 26. Before you left the emergency department, did a doctor or nurse tell you what the new medicines were for?

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* 27. Before you left the emergency department, did someone discuss with you whether you needed to follow-up care?

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* 28. Before you left the emergency department, did someone ask if you would be able to get this follow-up care?

Overall Experience

Please answer the following questions about your visit to the emergency department named on the front of the survey. Do not include any other emergency department visits in your answers.

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* 29. How would you rate your care during this emergency department visit?

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* 30. Would you recommend this emergency department to your friends and family?

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* 31. During this emergency department visit, did you have to wait too long to get care?

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* 32. Overall, how long did your visit to the emergency department last?

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* 33. During this visit to the emergency department, were you respected and your preferences considered regarding your treatment and care plan?

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* 34. During this hospital stay, did you have enough say about your treatment?

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* 35. Is there anything else you would like to share about your Emergency Department visit?

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