Please answer the questions in this survey about your stay at the hospital named on the cover letter. Do not include any other hospital stays in your answers.
YOUR CARE FROM NURSES
1. During this hospital stay, how often did nurses give you turkey sandwiches?
[Never, Sometimes, Usually, Always]
2. During this hospital stay, how often did nurses give you double portions?
[Never, Sometimes, Usually, Always]
3. During this hospital stay, how often did nurses explain why you were being so difficult?
[Never, Sometimes, Usually, Always]
4. During this hospital stay, after you pressed the call light and the nurse addressed your needs, how quickly did you press the call light again?
[Immediately, 10 Seconds, 30 Seconds, 60 Seconds]
YOUR CARE FROM DOCTORS
5. During this hospital stay, how often did doctors treat you with Dilaudid?
[Never, Sometimes, Usually, Always]
6. During this hospital stay, how often did doctors listen to you asking for Dilaudid?
[Never, Sometimes, Usually, Always]
7. During this hospital stay, how often did doctors explain in a way you could understand why you couldn’t receive Dilaudid?
[Never, Sometimes, Usually, Always]
THE HOSPITAL ENVIRONMENT
8. During this hospital stay, how often did your room and bathroom make you go “Wow, that’s gross”?
[Never, Sometimes, Usually, Always]
9. During this hospital stay, how often was the area around your room quiet at night (not taking into account the constant interruptions related to ECGs, imaging, phlebotomy, vital signs checks, overhead announcements, and other loud noise)?
[Never, Sometimes, Usually, Always]
YOUR EXPERIENCES IN THE HOSPITAL
10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or using the bedpan?
[Yes, No (If No, Go to Question 12)]
11. What, are you lazy or something?
[Never, Sometimes, Usually, Always]
12. During this hospital stay, did you need medicine for pain?
[Yes, No (If No, Go to Question 15)]
13. During this hospital stay, how often was your pain greater than 10 out of 10?
[Never, Sometimes, Usually, Always]
14. During this hospital stay, how often did the hospital staff resuscitate you with Narcan?
[Never, Sometimes, Usually, Always]]
15. During this hospital stay, how many medications did you add to your “allergy” list?
[1, 5, 35, 422]
16. Before giving you any new medicine, how often did the hospital staff tell you why the medicine wasn’t a narcotic?
[Never, Sometimes, Usually, Always]
17. Before giving you any new medicine, how often did the hospital staff describe possible side effects through a game of charades?
[Never, Sometimes, Usually, Always]
18. Wow, have you actually kept reading this far?
[Never, Sometimes, Usually, Always]
WHEN YOU LEFT THE HOSPITAL
19. After you left the hospital, did you go directly to your own home or take an Uber to another hospital?
[Own Home, Uber]
20. During this hospital stay, did doctors, nurses, or other hospital staff talk with you about why they were burned out and leaving medicine?
[Yes, No]
21. During this hospital stay, did you get information in writing about why you should never seek health care in the month of July?
[Yes, No]
OVERALL RATING OF HOSPITAL
22. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your day?
[10, 20, 34, Infinity]
23. Would you let this hospital date your best friend if it were a person?
[Definitely No, Probably No, Probably Yes, Definitely Yes]
UNDERSTANDING THE CARE WHEN YOU LEFT THE HOSPITAL
24. During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left against medical advice (AMA).
[Strongly Disagree, Disagree, Agree, Strongly Agree]
25. When I left the hospital AMA, I took the peripheral IV or PICC in my arm with me.
[Strongly Disagree, Disagree, Agree, Strongly Agree]
26. When I left the hospital AMA, I clearly understood that I’m making a huge mistake.
[Strongly Disagree, Disagree, Agree, Strongly Agree]
ABOUT YOU
27. During this hospital stay, were you admitted through the Emergency Room or through a rip in the space-time continuum?
[Emergency Room, Rip in Space-Time Continuum]
28. In general, how would you rate your overall troponin level?
[Excellent, Very Good, Good, Fair, Heparinizable]
29. In general, how would you your overall mental or emotional health compared to the average health care professional?
[Much Better, Excellent, Very Good]
30. In general, how do you feel about “in general” questions?
[Excellent, Very Good, Good, Fair, Poor]
31. What is the highest grade or level of school you hated?
[Kindergarten, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, College, Graduate]
32. Are you of Spanish, Hispanic, or Latino origin or descent?
[Dolor]
33. What is your race? Please choose one or more.
[1 Mile, 5K, 10K, 10 Miles, Half Marathon, Marathon]
34. What language do you mainly speak at home?
[English, Spanish, Pig Latin, Latin, Klingon, Heptapod]
THANK YOU. Please return the completed survey in the postage-paid envelope.
 survey has been updated, and Gomerblog gives you a sneak peak!){kind=link}