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2025 Emergency Department

Client Experience Questionnaire

Tell us about your experience! Your feedback helps us to improve the way we provide care. This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness, and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank

Note: All questions in this survey should be related to the last visit.
Survey responses provided by:
What gender do you identify with:
Which Emergency Department did you visit on this occasion?
Dignity, Respect and Trust:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  You were treated with respect.
b.  Your privacy was respected as best it could be.
c.  Your cultural needs were considered.
(e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
d.  Before providing care, staff members introduced themselves to you, where appropriate.
e.  In general, staff were compassionate.
Information Sharing
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff talked to you about what medications you are taking at home.  (e.g. prescription, supplements, herbal, etc.)
b.  Staff talked to you about your health care options.  (e.g. procedures/tests)
c.  Your health care provider used words you could understand.
d.  You had the necessary information needed to make good decisions about your health.
e. The staff kept your information confidential and secure.
Participation:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff involved you or your family/support system in making decisions about your care.
b.  You were encouraged to take part in your care as much as you are/were able.
c.  Your choices were respected.
d.  You are/were comfortable expressing concerns about your care.
Accessibility and Responsiveness:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  Your care was well coordinated.
b.  You were cared for in a timely manner.
c. You had access to the care you needed.
d.  Your concerns were taken seriously.
e. You are aware of the Prairie Mountain Health (PMH) services and programs available to get the support you need for your health care journey.
Quality:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  You saw the health care provider(s) clean their hands before providing your care.
b.  Your identity was confirmed before receiving care.  (e.g. asked your name, checked your wrist band, asked your date of birth)
Quality:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. Your healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. proper foot wear, medication changes, etc.).
d.  You felt staff were up to date on the skills needed to provide your care.
e.  Overall, you are/were satisfied with the quality of care you received.
Emergency Department Program Specific Questions:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. Staff checked on me regularly after my initial assessment.
b. Staff managed your pain during your visit.
c. Before leaving the Emergency Department, you had a clear understanding of any new medications being prescribed.
d. During this visit you received information about how to care for yourself after being discharged from the Emergency Department.
e. During this visit the staff talked with you about whether you would have the help you needed after you left the Emergency Department.
f. You received enough information from health care providers about what to do if you had further concerns that caused this visit to the Emergency Department.
g. Overall, the Emergency Department met your expectations.
Emergency Department Program Specific Questions:
(If question does not apply, leave blank)
Yes
No
h. Do you feel your Emergency Department visit could have been avoided if you had an electronic/virtual option to discuss your care needs with your health care provider. (e.g. Zoom, Skype, Telehealth, Telephone)
i. At the time of your visit to the Emergency Department did the practitioners discuss your Mental Health?
Emergency Department Program Specific Questions:
(If question does not apply, leave blank)
Yes
No
Not Applicable
j. Were you provided Mental Health resources you required at the time of your visit to the Emergency Department?
Comments:

Forward additional Concerns or Compliments regarding your care to Patient Relations.

Patient Relations: email patientrelations@pmh-mb.ca or call 1-800-735-6596
Demographics:   (of the patient)
Ethnicity:
Age of patient:
Emergency Department Patient Partner Volunteers Needed!! Someone just like you helped to design this survey! We want to partner with existing Emergency Department patients or family members who might be interested in helping us review, design or provide feedback to our services.

If you would like more information or if you think you might be interested in becoming a Patient Partner, please click on the link below or contact Patient Relations by calling 1-800-735-6596.

https://prairiemountainhealth.ca/forms/patient-partner/
Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca

Thank you for your participation!