Emergency Patients Satisfaction Survey

Facility *

How long did you wait before you were seen by the triage nurse?

0-15 min

16-30 min

31-60 min

More than 60 min

Were you able to discuss your problem privately with the triage nurse, without other people hearing you?

Yes, definitely

Yes, to some extent

No

From when you first arrived at the Emergency, how long did you wait before being examined by a doctor?

I didn’t have to wait

1-30 min

31-60 min

1-2 h

2-4 h

More than 4 h

I left before seeing a doctor

Did the staff introduce themselves, stating their name and role, before examining you?

Yes, always

Yes, sometimes

Never

Did you have enough time to discuss your health problem with the staff?

Yes, definitely

Yes, to some extent

No

Did the staff listen to what you had to say?

Yes, definitely

Yes, to some extent

No

Was your privacy respected by the staff during treatments or examinations? (e.g. closed the door, pulled the curtain)

Yes, definitely

Yes, to some extent

No

Did the staff explain your condition and treatments in a way you understood?

Yes, definitely

Yes, to some extent

No

I didn’t need any explanations

Were you able to get help from the staff, if necessary?

Yes, always

Yes, sometimes

No, I couldn’t find a staff member to help me

A staff member was with me all the time

I didn’t need any help

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

Yes, definitely

Yes, to some extent

No

I wasn’t well enough to be involved

Were the results of the tests you had during your visit explained to you? (e.g. X-rays, blood tests)

Yes, definitely

Yes, to some extent

No

The results were not available

I had no tests done

Before giving you a medication, did the staff tell you what it was for?

Yes, always

Yes, sometimes

Never

I wasn’t given any medication

Did the staff manage to control your pain?

Yes, definitely

Yes, to some extent

No

I had no pain

In your opinion, how clean was the Emergency Department?

Very clean

Fairly clean

Not very clean

Not clean at all

During this visit to the Emergency, did the staff treat you with respect and dignity?

Yes, always

Yes, sometimes

No

Did you notice the staff washing or disinfecting their hands before caring for you?

Yes, always

Yes, sometimes

Never

I didn’t notice

I didn’t see any facilities for washing/disinfecting hands

Did the staff check your identification band before giving you medication or performing treatments/tests?

Yes, always

Yes, sometimes

No

I don't remember

Before leaving the Emergency, did the staff explain the reason and side effects of new prescribed medications?

Yes, definitely

Yes, to some extent

No

I wasn’t prescribed any new medication

Did a staff member tell you about signs and symptoms to watch for at home regarding your health problem or treatment?

Yes, definitely

Yes, to some extent

No

No, I didn’t need this information

No, I was admitted

Did a staff member tell you who to contact if you were worried about your health condition or treatment after you left the Emergency?

Yes

No

How often did you receive the service you needed in the official language (English or French) of your choice at the Emergency?

Always

Usually

Sometimes

Never

Overall, how was your experience in the Emergency?

0 being the worst experience and 10 the best

Comments

Optional

Name

Telephone