Emergency Department Patient Feedback Form

Please rate the following questions regarding your experience at BGH:

I knew where to go when I arrived at the Emergency Department *

I felt welcomed and respected as a patient throughout my visit. *

After you arrived at the Emergency Department, how long was it until you talked to a NURSE about your illness or injury? *

Once you went to a bed or an examination room, about how long did you have to wait to see a doctor? *

Do you feel you had to wait too long to see a doctor? *

Yes, definitely

Yes, somewhat

No

My privacy/confidentiality was respected at all times. *

My diagnosis, treatment, and any education materials provided to me were explained to me in a way that I could understand. *

I was given clear discharge instructions (e.g. dietary or physical restrictions, new medications, symptoms to watch for, etc.) to be able to manage my condition at home. *

My questions were answered promptly and in a way that I could understand. *

I found the patient area to be comfortable and pleasant. *

My room and the hospital in general was clean. *

Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during your Emergency Department visit? *