Questions for Primary Care Physicians Regarding Hospital Discharge Pro

Project RED (Re-Engineered Discharge) Training Program

Provides a four-module training program to help hospitals implement Project RED.

NAME OF HOSPITAL is redesigning its patient discharge process to make it more patient centered, comprehensive, and coordinated with post-discharge caregivers. As a primary care provider, we would like your help in assessing the effectiveness of this improvement effort. Please complete this brief survey with our current discharge program in mind. We would like to ask you to complete the survey again in a few months after we've implemented our new activities. It should only take you a few minutes, and can be returned using the fax number provided below.

Circle the response that best describes your level of agreement:

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
1	2	3	4	5
1. As a referring physician, I think the hospital's discharge process is effective at preparing my patients for discharge.			1 2 3 4 5
2. The hospital sends me discharge information within 24 to 78 hours of my patient's discharge.			1 2 3 4 5
3. The care plans given to my patients at discharge provide information that is clear and direct.			1 2 3 4 5
4. When my patients come to me for their follow-up appointments, they can describe why they were admitted and can follow the discharge instructions given by the hospital.			1 2 3 4 5
5. My patients have follow-up appointments scheduled prior to leaving the hospital.			1 2 3 4 5
6. My patient/family knows and understands the medications (dose, route, procedure, schedule, etc.) upon discharge.			1 2 3 4 5
Comments:

Check your title:
____Physician ____Nurse Practitioner ____Physician Assistant ____Other:

Thank you for your response. Please fax this form to: ________________________

Optional:
Name: Contact Information:

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Page last reviewed August 2011

Internet Citation: Questions for Primary Care Physicians Regarding Hospital Discharge Pro: Project RED (Re-Engineered Discharge) Training Program. August 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/systems/hospital/red/primary.html