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Patient experience

Hospital stay and discharge survey template

Admission, ward care, communication, discharge instructions and knowing who to call afterwards.

5 questions · about 4 minutes to complete · free on every plan

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Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it
One week after discharge.
Who it is for
Recently discharged patients or their carers.

How to use this template

  1. Send it within 48 hours of the visit; response rates and recall both fall the longer you wait.
  2. Ask about communication ('explained things in a way I understood') before overall satisfaction.
  3. Do not ask for diagnoses or medications in a general feedback survey.

Questions in the hospital stay and discharge survey template

  1. 1. Who is completing this survey?

    single choice · The patient, A family member or carer

  2. 2. Rate each part of the stay

    matrix · Admission process, Nursing care, Doctors' communication, Cleanliness, Food, Noise at night, Discharge process

  3. 3. When you left hospital…

    matrix · I understood what to do at home, I knew what warning signs to look for, I knew who to contact with questions, Medication instructions were clear

  4. 4. Overall, how would you rate your care?

    rating

  5. 5. What could have been better?

    open text

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.Who is completing this survey?

120 answered
Answer distribution
AnswerCountPercent
The patient8571%
A family member or carer3529%

2.Rate each part of the stay

120 answered
StatementPoorFairGoodVery goodExcellentn
Admission process5%18%15%25%37%120
Nursing care6%13%14%21%47%120
Doctors' communication8%8%23%28%34%120
Cleanliness8%8%20%23%41%120
Food12%9%24%22%33%120
Noise at night11%12%25%14%38%120
Discharge process7%16%23%23%32%120

3.When you left hospital…

120 answered
StatementStrongly disagreeDisagreeNeutralAgreeStrongly agreen
I understood what to do at home9%7%23%33%29%120
I knew what warning signs to look for6%11%19%31%33%120
I knew who to contact with questions7%18%20%23%33%120
Medication instructions were clear7%11%19%22%42%120

4.Overall, how would you rate your care?

120 answered
Average 6.8
Answer distribution
AnswerCountPercent
176%
298%
365%
4108%
587%
676%
71210%
81513%
91714%
102924%

How to read these questions

  • single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.
  • matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.
  • rating: Report the mean and the top-two-box share (the two highest points). Top-two-box is easier to explain and less sensitive to a few extreme answers.

Frequently asked questions

Does a patient satisfaction survey need HIPAA safeguards?

If it collects no health information and is anonymous, generally no. If you link responses to patient records or ask about conditions, treat it as protected health information and get advice.

How long does the hospital stay and discharge survey take to complete?

About 4 minutes: 5 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.

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