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Questionnaire

DAY SURGERY Questionnaire


Dear Sir/Madam,

Would you please take some time to answer the questions in this booklet. It is important for us to know what you think about our Day Hospital as a patient or caregiver.
Your comments will help us better our service, to make the day hospital experience a positive and above all tailored to fit the patient. Your views and comments will be strictly confidential.

Thanking you in advance for your kind cooperation,

Dott. U. Feelbetter
Head, Day Surgery Unit


1. Age:
 18 years or younger  51-60 years
 19-30 years old  61-70 years
 31-50 years  over 71

2. Gender.
 male  female

3. Education
 Junior high school
 High School diploma or equivalent
 College Degree or higher

4. Profession
 employed  unemployed
 student  housewife
 retired
 other
5.
Who referred you the Day Surgery Center?
 A friend
 Your primary physician
 A specialist
 Other
Please specify_

6. Is this the first time at the Day Surgery Center?
 Yes
 No, it is my second time
 No, it is my third time or more

7. How did you make your first appointment?
 By telephone
 In person at the Center

8. Did you have any difficulty with the telephone service?
 No
 Yes, I had to call back many times
 Other

9. If you came in person, how would you judge our direction signs?

Score between 1 and 5 where 1 = Very Confusing and 5 = Very Clear

10. How long did you have to wait before your first appointment?
 Less than 2 weeks  1 to 2 months
 2 weeks to 1 month  over 2 months

11. How would you rate the waiting time?

Score between 1 and 5 Where 1 =Too Long 3= Just right and 5 = Too Short

12. Were you adequately informed about the possible waiting time for your first visit?
 Yes  No

13. Was the information received regarding day surgery, preparation for day surgery, instructions and procedures clear and adequate?

Score between 1 and 5 where 1= Unclear and 5= Very Clear

Score between 1 and 5 where 1= Inadequate and 5 = Adequate

14. How would you rate the written information given to you? (circle one)

Score between 1 and 5 where 1 = Useless and 5 = Very useful


14a. If information was inadequate, what information needs to be added or changed to make it more useful?


14b. If there was too much information, what should be eliminated?


15. What information was most helpful to you?
 Oral  written  both

16. In what other ways could our brochures be improved to better fit our patients’ needs?


17. How would you rate your greeting by the Day Surgery Center personnel on the day of your surgery?

Score between 1 and 5 where 1= Cold and 5 = Very warm


18. How would you judge the comfort of our waiting room?

Score between 1 and 5 where 1 = Uncomfortable and 5 = Comfortable
1 2 3 4 5

18a. In what ways was it uncomfortable/comfortable?


19. If you underwent an operation, who was the most reassuring before the operation?
 The surgeon
 The nursing staff
 The anaesthetist
 No one
 Other___

20. How would you rate the information received regarding post-operative instructions and check-ups?

Score between 1 and 5 where 1 = Incomprehensible and 5 = Very understandable

21. When you were discharged from day surgery, were the personnel helpful?

Score between 1 and 5 where 1 = Not at all and 5 = Very helpful


22. What aspects of the Day Surgery Center did you find favourable? (check all that apply)
 Organization  Medical assistance
 Nursing assistance  Equipment
 Administrative aspects
 Comfort and cleanliness of the environment

23. What aspect of the Day Surgery Center did you find unfavourable? (check all that apply)
 Organization  Medical assistance
 Nursing assistance  Equipment
 Administrative aspects
 Comfort and cleanliness of the environment

24. How would you overall rate our Day Surgery Center?

Score between 1 and 10 where 1 = Negative and 10 = Positive


26. What suggestions could you make to help us improve the quality of our service?

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