Emergency Room (ER) Survey Please complete the following questions to the best of your knowledge. All information provided will be kept confidential and will only be used in a report by the Oklahoma Health Care Authority on SoonerCare members’ ER use. Question Title * 1. Think of the last time you (SoonerCare member) or your SoonerCare enrolled family member went to the ER. What day was it? (Please select one) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Question Title * What time of day did you go? (Please select one) 8 a.m. and noon Noon and 4 p.m. 4 p.m. and 8 p.m. 8 p.m. and midnight Midnight and 8 a.m. Question Title * Was it for a life-threatening emergency? (Please select one) yes no Question Title * 2. Is the SoonerCare member who went to the ER (Please check one) Male Female Question Title * 3. Is the SoonerCare member who went to the ER (Please check one) Over age 18 18 years or younger Question Title * 4. Tell us the reasons you, or your SoonerCare family member, went to the ER. (Select all that apply) Life-threatening emergency You feel the problem is too serious for PCP (primary care provider) You were taken by ambulance After hours care not available at your PCP PCP nurse advice line told you to go the ER PCP or clinic told you to go to the ER Can’t take off work to go to PCP Convenience – ER is open 24 hours a day Other (please specify) Question Title * 5. Are you concerned about ER wait times? (Please select one) Yes No Please explain your concern about ER wait times. Question Title * 6. Do you worry you might ‘catch something’ in the ER? (Please select one) Yes No Question Title * 7. Does cost influence your decision to go to the ER instead of your PCP? (Please select one) Yes No Question Title * 8. Have you ever had an employee at the ER talk to you about lower-cost alternatives? For example, your PCP, an urgent care clinic, minor emergency, etc.? (Please select one) Yes No Question Title * 9. Are there urgent care clinics in your community that are open all day every day? (i.e. AM/PM Doctors Urgent Care, First Med Urgent Care or extended hours clinics? (Please select one) Yes No Question Title * a. Do these clinics have open scheduling (walk-ins or same-day appointments)? (Please select one) Yes No Question Title * b. Have you gone to one of these clinics? (Please select one) Yes No Why or why not? Question Title * 10. What would make you more likely to go to your PCP or an after-hours clinic instead of the ER? (Please select one) Able to get immediate appointment with PCP or clinic If PCP or clinic was open more/later hours Shorter travel to PCP or clinic Illness/accident was less serious Available ride other than ambulance Other – please list Question Title * 11. Do you have any other comments about the ER? Done
