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Post Discharge Inpatient Feedback Form Template

Collect patient feedback for hospital discharge and measure their experience with various aspects of the stay to improve patient satisfaction using this post discharge inpatient (IPD) feedback form template.

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Measure inpatient satisfaction and experience during their stay at your healthcare facility or hospital. Gauge patient satisfaction with the treatment provided, quality of food, staff friendliness, cleanliness and more with this detailed patient discharge form template. 

Post Discharge IPD Feedback Form Questions

  1. 1. Please rate your overall experience at the hospital
  2. 2. Please rate the following aspects of our hospital
    • Cleanliness
      • Poor
      • Fair
      • Good
      • Very Good
      • Excellent
    • Staff Courtesy
      • Poor
      • Fair
      • Good
      • Very Good
      • Excellent
    • Communication
      • Poor
      • Fair
      • Good
      • Very Good
      • Excellent
    • Pain Management
      • Poor
      • Fair
      • Good
      • Very Good
      • Excellent
  3. 3. How was the ambiance of the hospital?
  4. 4. How would you rate the ward facilities?
  5. 5. How would you rate the toilets and changing rooms in the hospital?
  6. 6. How was the food and diet served to you during your stay?
  7. 7. How would you rate the attitude and service of the attending doctor?
  8. 8. How would you rate the billing process at the hospital during discharge?
  9. 9. How was the reception and inquiry service?
  10. 10. How would you rate the admission process?
  11. 11. How would you rate the discharge process?
  12. 12. Based on your experience, how likely are you to recommend us to your friends and colleagues for their treatment?
    • 0 (Not at all likely)
    • 10 (Extremely likely)
  13. 13. Please share your comments and reasons for the score here
  14. 14. Personal Information
    • Full Name
    • Email Address
    • Mobile Number
    • Patient ID

The Patient Discharge Feedback Form Template is a common tool used in healthcare settings to gather data on patient experience regarding the discharge process. It offers several benefits to streamline the discharge process and ensure consistent documentation. This allows the healthcare providers in delivering high quality care. 

Zonka Feedback's IPD Feedback Form Template includes a mix of rating scales, button choices, and open-ended questions, offering flexibility to the patients to express themselves better. Healthcare facilities can easily customize the patient discharge form template to suit their needs and patient demographics. The form is fully-customizable and is designed to be user-friendly, ensuring the patients of all ages and backgrounds can easily fill it. The collected feedback can be reviewed by hospital staff, including doctors, nurses, and administrators, to address any areas of concern. 

The essential elements of an Patient Discharge IPD feedback form template typically asks for details and feedback including: Patient Info (age, patient ID, contact details, etc), medications, diagnosis, follow-up instructions, and post-discharge care. 

There are several effective ways to collect patient feedback using Hospital Discharge Form Template. For starters, you can trigger email surveys after the patients have been discharged. Another effective way is to install survey kiosks within hospital or clinic premises, especially at the reception area, where patients can complete the survey before leaving the facility.

Other ways include sms surveys, link surveys, and mobile app surveys if your healthcare facility has mobile application. Healthcare facilities that embrace such surveys can benefit from the improved patient satisfaction and build trust with your organization. By prioritizing IPD feedback forms, hospitals can deliver quality care, and reduce readmission rates.

Post Discharge IPD Feedback Form Template FAQ

  1. What is the purpose of the Post-discharge IPD feedback form?
    The Post-discharge IPD feedback form aims to gather feedback from patients who have recently been discharged from an in-patient department. It helps assess their experience, identify areas of improvement, and enhance the quality of care provided.
  2. What information should be included in the IPD feedback form?
    The IPD feedback form should include questions about various aspects of the patient's hospital stay, such as the quality of care, communication with healthcare providers, cleanliness of the facility, discharge process, and overall satisfaction.
  3. Can I customize the questions in the IPD feedback form template?
    Yes, the IPD feedback form template is fully customizable. You can modify the existing questions, add new questions, or remove questions that may not be applicable to your specific IPD experience.
  4. Is the IPD feedback form anonymous?
    Yes, patient feedback can be kept anonymous to encourage honest and unbiased responses. However, if patients choose to provide their personal information voluntarily, it can be used for follow-up purposes or to address specific concerns.
  5. How should I interpret the rating scales or response options in the IPD feedback form?
    The rating scales or response options typically range from 1 to 5 or from Very Dissatisfied to Very Satisfied. Patients can choose the option that best reflects their experience or satisfaction level for each question.

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