Q1 | During this hospital stay, how often did nurses treat you with courtesy and respect? | Response Format - Never
- Sometimes
- Usually
- Always
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Q2 | During this hospital stay, how often did nurses listen carefully to you? |
Q3 | During this hospital stay, how often did nurses explain things in a way you could understand? |
Doctor Communication |
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Q5 | During this hospital stay, how often did doctors treat you with courtesy and respect? | Response Format - Never
- Sometimes
- Usually
- Always
|
Q6 | During this hospital stay, how often did doctors listen carefully to you? |
Q7 | During this hospital stay, how often did doctors explain things in a way you could understand? |
Explanation of Medicines |
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Q16 | Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? | Response Format - Never
- Sometimes
- Usually
- Always
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Q17 | Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? |
Timely Help from Hospital Staff |
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Q4 | During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? | Response Format - Never
- Sometimes
- Usually
- Always
- For question 4 only: I never pressed the call button
|
Q11 | How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? |
Information About Recovery |
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Q19 | During your hospital stay, did hospital staff talk with you about whether you would have the help you needed when you left the hospital? | Response Format |
Q20 | During your hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? |
Pain Control |
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Q13 | During this hospital stay, how often was your pain well controlled? | Response Format - Never
- Sometimes
- Usually
- Always
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Q14 | During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? |
Individual Items |
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Cleanliness | Response Format - Never
- Sometimes
- Usually
- Always
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Q8 | During this hospital stay, how often were your room and bathroom kept clean? |
Quiet at Night |
Q9 | During this hospital stay, how often was the area around your room quiet at night? |
Ratings |
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Overall Rating of Hospital | Response Format |
Q21 | 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? |
Would Recommend Hospital | Response Format - Definitely no
- Probably no
- Probably yes
- Definitely yes
|
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Q22 | Would you recommend this hospital to your family and friends? |