Canadian Patient Experiences Survey - Inpatient Care Survey Instructions

Please complete this questionnaire only if you were a recent patient at GBHS. You may need to get help from a family member or friend to answer the questions.  That's okay.
 
Answer all the questions by selecting the appropriate box.
 

What Hospital did you experience your inpatient care at?

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* 1. What Hospital did you experience your inpatient care at?

YOUR CARE FROM NURSES
During this stay at the hospital, how often did nurses treat you with courtesy and respect?

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

During this stay at the hospital, how often did nurses listen carefully to you?

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

During this stay at the hospital, how often did nurses explain things in a way you could understand?

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

During this stay at the hospital, after you pressed the call button, how often did you get help as soon as you wanted it?

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* 5. During this stay at the hospital, after you pressed the call button, how often did you get help as soon as you wanted it?

YOUR CARE FROM DOCTORS
During this stay at the hospital, how often did doctors treat you with courtesy and respect?

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

During this stay at the hospital, how often did doctors listen carefully to you?

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

During this stay at the hospital, how often did doctors explain things in a way you could understand?

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

THE HOSPITAL ENVIRONMENT
During this stay at the hospital, how often were your room and bathroom kept clean?

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

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

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

YOUR EXPERIENCES IN THIS HOSPITAL
During this stay at the hospital, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?

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

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

During this stay at the hospital, did you need medicine for pain?

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* 13. During this stay at the hospital, did you need medicine for pain?

During this stay at the hospital, how often was your pain well controlled?

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* 14. During this stay at the hospital, how often was your pain well controlled?

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

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

During this stay at the hospital, were you given any medicine that you had not taken before?

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

Before giving you any new medicine, how often did hospital staff at the hospital tell you what the medicine was for?

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

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

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

WHEN YOU LEFT THE HOSPITAL
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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* 19. After you left the hospital, did you go directly to your own home, to someone else's home or to another health facility?

During this stay at the hospital, 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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* 20. During this stay at the hospital, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?

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

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* 21. During this stay at the hospital, 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 named on the survey.  Do not include any other hospital stays in your answers.
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?

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* 22. 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?

Would you recommend this hospital to your friends and family?

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

YOUR ARRIVAL AT THE HOSPITAL
When you arrived at the hospital, did you go to the emergency department?

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

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

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

Was your admission into the hospital organized?

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* 26. Was your admission into the hospital organized?

Go to Question 30


Answer questions 26 to 29 only if you were admitted through the emergency department.
When you were in the emergency department, did you get enough information about your condition and treatment?

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

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

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

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

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

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

Continue with Question 30

DURING YOUR HOSPITAL STAY
Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?

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

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

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

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

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

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

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

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

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

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

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

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

LEAVING THE HOSPITAL
Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your hospital stay?

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

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

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

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

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

YOUR OVERALL RATINGS
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."

Overall..... (Please select a number)

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* 41. 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."

Overall..... (Please select a number)

Overall...... (Please select a number)

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* 42. Overall...... (Please select a number)

ABOUT YOU
In general, how would you rate your overall health?

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

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

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

What is the highest level of school that you have completed?

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* 45. What is the highest level of school that you have completed?

What is your gender?

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* 46. What is your gender?

In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 47. In what year were you born? (enter 4-digit birth year; for example, 1976)

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

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

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

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

What is your mother tongue?

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* 50. What is your mother tongue?

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

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

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