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* 1. Please indicate from which NOSH site you accessed inpatient care services:

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* 2. Was your most recent visit a:

Please answer the questions about your most recent stay at the hospital you chose above. Do not include any other hospital stays in your answers.
Your care from nurses

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* 3. During this hospital stay, how often did nurses treat you with courtesy and respect?

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* 4. During this hospital stay, how often did nurses listen carefully to you?

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* 5. During this hospital stay, how often did nurses explain things in a way you could understand?

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* 6. 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

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* 7. During this hospital stay, how often did doctors treat you with courtesy and respect?

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* 8. During this hospital stay, how often did doctors listen carefully to you?

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* 9. During this hospital stay, how often did doctors explain things in a way you could understand?

The hospital environment

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* 10. During this hospital stay, how often were your room and bathroom kept clean?

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* 11. During this hospital stay, how often was the area around your room quiet at night?

Your experiences in this hospital

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* 12. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?

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* 13. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

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* 14. During this hospital stay, did you need medicine for pain?

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* 15. During this hospital stay, how often was your pain well controlled?

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* 16. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

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* 17. During this hospital stay, were you given any medicine that you had not taken before?

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* 18. Before giving out any new medicine, how often did hospital staff tell you what the medicine was for?

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* 19. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

When you left the hospital

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* 20. After you left the hospital, did you go directly to your own home, to someone else’s home or to another health facility?

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* 21. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?

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* 22. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

Overall rating of hospital

Please answer the following questions about your stay at the hospital chosen in question 1. Do not include any other hospital stays in your answers.

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* 23. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

0 10
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i We adjusted the number you entered based on the slider’s scale.

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

Your arrival at the hospital

In this next section, we are several most questions about your stay at the hospital.

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* 25. When you arrived at the hospital, did you go to the emergency department?

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* 26. Before coming to the hospital, did you have enough information about what was going to happen during the admission process?

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* 27. Was your admission into the hospital organized?

Answer questions 28 to 31 only if you were admitted through the emergency department. If you were not admitted through the emergency department, please continue to question 32.

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* 28. When you were in the emergency department, did you get enough information about your condition and treatment?

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* 29. Were you given enough information about what was going to happen during your admission to the hospital?

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* 30. After you knew that you needed to be admitted to a hospital bed, did you have to wait too long before getting there?

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* 31. Was your transfer from the emergency department into a hospital bed organized?

During your hospital stay

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* 32. Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?

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* 33. How often did doctors, nurses and other hospital staff seem informed and up-to-date about your hospital care?

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* 34. How often were tests and procedures done when you were told they would be done?

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* 35. During this hospital stay, did you get all the information you needed about your condition and treatment?

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* 36. Did you get the support you needed to help you with any anxieties, fears or worries you had during this hospital stay?

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* 37. Were you involved as much as you wanted to be in decisions about your care and treatment?

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* 38. Were your family or friends involved as much as you wanted in decisions about your care and treatment?

Leaving the hospital

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* 39. Before you left the hospital, did you have a clear understanding about all your prescribed medications, including those you were taking before your hospital stay?

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* 40. Did you receive enough information from hospital staff about what to do if you were worried about your condition and treatment after you left the hospital?

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* 41. When you left the hospital, did you have a better understanding of your condition than when you entered?

Your overall ratings

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* 42. Overall, do you feel you were helped by your hospital stay? Please answer on a scale where 0 is “not helped at all” and 10 is “helped completely”

0 10
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i We adjusted the number you entered based on the slider’s scale.

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* 43. Overall, how was your experience during your hospital stay? Please answer on a scale where 0 is “I had a very poor experience” and 10 is “I had a very good experience”.

0 10
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i We adjusted the number you entered based on the slider’s scale.
About you

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* 44. In general, how would you rate your overall physical health?

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* 45. In general, how would you rate your overall mental or emotional health?

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

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* 47. What is your gender?

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* 48. What is your year of birth?

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* 49. Was your most recent stay at this hospital for a childbirth experience?

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* 50. The following question will help us better understand the communities that we serve. Do you consider yourself to be...
(Check all that apply)

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* 51. Is there anything else you would like to share about your hospital stay?

Questions 3 to 24 and 45 are adapted from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) questionnaire.

Questions 25 to 51 (excluding question 43) were adapted and/or developed by the Canadian Institute for Health Information in consultation with an inter jurisdictional committee of experts.

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