PATIENT SATISFACTION QUESTIONNAIRE [29]

THIS QUESTIONNAIRE IS ANONYMOUS AND CONFIDENTIAL!

YOUR RESPONSES ARE VERY IMPORTANT TO US!

Dear Patient,

In order to evaluate the medical care you received at the County Clinical Emergency Hospital Bihor and to improve the QUALITY of medical care, please kindly answer the questions below.

Answer the questions by choosing the option that best suits you.

Mark with an X in the box (□) corresponding to one of the answer options.

Mark with an X in the box (□) corresponding to the rating (1—the lowest and 5—the highest).

Please deposit the completed form in the boxes located in the ward where you were admitted.

1. In which ward were you admitted:

2. You are:      □ female      □ male      □ no answer

3. Place of residence:      □ rural      □ urban      □ no answer

4. Your age: ................... years      □ no answer

5. Highest level of education completed:

□ primary (4 grades)      □ junior high school

□ high school, vocational      □ higher education      □ no answer

6. How did you come to be admitted to our hospital:

□ you presented yourself directly to the emergency department      □ you came by ambulance

□ you had a referral from your family doctor      □ you had a referral from the outpatient doctor

□ other situation      □ no answer

7. When you first entered this facility, what was your initial impression? Choose three words that best describe the situation in the reception area at that time.

□ cleanliness      □ luxury      □ calm      □ discipline

□ disorder      □ poverty      □ filth      □ overcrowding      □ no answer

8. Did the situation in the reception area, as you have just described, affect your mood? (mark only one option)

□ it demoralized me      □ it had no effect      □ it boosted my morale      □ no answer

9. Were you accompanied by healthcare personnel from the Admissions Office to the ward?

□ yes      □ no      □ no answer

10. Were you accompanied by relatives from the Admissions Office to the ward?

□ yes      □ no      □ no answer

11. Were you accompanied by designated personnel during your movement within the hospital (e.g., for examinations)?

□ yes      □ no      □ no answer

12. Do you know the identity of the medical staff involved in providing your care?

□ yes      □ no      □ no answer

13. How do you rate the quality of communication and the attitude of the hospital staff?

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

14. How do you rate the quality of medical care provided by: (1—lowest, 5—highest)

a. Your doctor:

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

b. Nursing staff:

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

c. Nursing assistants:

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

15. Were you informed about your rights and responsibilities in the hospital?

□ yes, at the Admissions Office      □ yes, verbally only      □ no      □ no answer

16. Were you informed about how to submit suggestions and complaints?

□ yes      □ no      □ no answer

17. Were you informed about the estimated discharge date?

□ yes      □ no      □ no answer

18. Were you informed about the risk of falling?

□ yes      □ no      □ no answer

19. Were you informed about your diagnosis?

□ yes      □ no      □ no answer

20. Did you receive information about the progression of your illness and the therapeutic plan to be followed?

□ yes      □ no      □ no answer

21. Were you informed about the adverse effects of the medications administered in the hospital?

□ yes      □ no      □ adverse effect: ................................      □ no answer

22. Can you name a medication that was administered to you in the hospital?

□ no      □ please specify the medication: ................................      □ no answer

23. During your hospitalization, did you purchase any medications?

□ yes      □ no      □ please specify the medication: ........................      □ no answer

24. Were the medication vials opened in front of you?

□ yes      □ no      □ not applicable      □ no answer

25. Does the medical staff use single-use gloves for every contact with you?

□ yes      □ no      □ no answer

26. Were you operated on during your hospitalization?

□ yes      □ no      □ no answer

27. How would you rate the postoperative care and medical services provided in the Intensive Care Unit (if applicable)? (1—lowest, 5—highest)

□ 1      □ 2      □ 3      □ 4      □ 5      □ not applicable/no answer

28. Did you experience any postoperative complications?

□ yes      □ no      □ no answer

29. During your hospitalization, did you reward any medical staff (doctor, nurse, nursing assistant, orderly, etc.) with money or gifts?

□ yes      □ no      □ no answer

30. If your answer to the previous question was YES, please specify the professional category of the medical staff:

□ doctor      □ nurse      □ nursing assistant/caregiver

□ orderly      □ others      □ not applicable

31. How would you rate the quality of the food and the manner in which it is distributed in the hospital? (1—lowest, 5—highest)

□ 1      □ 2      □ 3      □ 4      □ 5      □ not applicable/no answer

32. Are you satisfied with the accommodation conditions in the ward (quality of bedding, hospital attire, equipment, facilities)?

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

33. How would you rate the cleanliness of your ward? (1—lowest, 5—highest)

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

34. Please specify how many times per day cleaning is performed in your ward:

□ once per day      □ as needed      □ twice per day      □ no answer

35. What is your opinion of the hospital environment (appearance of the ward, corridor, restroom, courtyard)? (1—lowest, 5—highest)

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

36. Is the visiting schedule respected in the ward where you were admitted?

□ yes      □ no      □ no answer

37. Have you been admitted to this hospital before?

□ yes      □ no      □ no answer

38. If you were in need of medical services, would you return here? (1—definitely not; …5—definitely yes)

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

39. Were you satisfied with the spiritual assistance provided within the hospital?

□ yes      □ no      □ no answer

40. What is your overall impression of the hospital? (1—lowest, 5—highest)

□ 1      □ 2      □ 3      □ 4      □ 5      □ no answer

COMMENTS OR SUGGESTIONS to improve the quality of medical care:

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