After Medical Harm: How Did the Hospital Treat You and Your Family?

Posted in Patient Resources

What Did the Patient’s Doctor or Other Hospital Staff Tell You About the Serious Injury or Death Involving a Possible Medical Error?

This questionnaire asks what happened after you or a family member experienced a serious, unexpected injury or death that you believe may have involved a medical error in a hospital. We are asking for your opinion. You do not need medical or legal experts to have determined that the adverse event was an error.

Privacy and Permission

Your contact information will remain private. The questionnaire results may be published, but no identifying information will be published.

Please do not provide Social Security numbers, complete dates of birth, or other sensitive identifying information.

State the hospital where the event occurred *

Year of the event *

Your name

Your email address

May Hospital Watchdog contact you about your experience? *YesNo

1. How Did You First Learn Something May Have Gone Wrong? *Select one.A doctor, nurse, or other hospital employee voluntarily told meA hospital employee told me only after I asked questionsI discovered it by observing the patient’s conditionI learned from the medical recordsI learned through a complaint, investigation, or legal caseI still do not know exactly what happenedNot sure

2. When Did Hospital Staff Discuss the Event? *Select one.Within six hoursMore than six hours but within 24 hoursMore than one day but within several daysOnly after I repeatedly requested an explanationOnly after I filed a complaint or took legal actionNo one from the hospital discussed it with meNot sure

3. Did the Hospital Admit The Patient Was Harmed By Error? *Select one.Yes, voluntarilyYes, but only after I askedYes, but only after repeated pressure or a formal complaintThe hospital acknowledged the injury but denied that an error occurredThe hospital denied that any harm occurredThe hospital ignored or did not answer the questionNot sure

4. Did the Doctor Describe What Caused The Patient’s Harm? *Select one.Yes, voluntarilyYes, but only after I askedYes, but only after repeated pressure or a formal complaintThe doctor acknowledged the injury but denied making an errorThe doctor denied that any harm occurredThe doctor did not answer the question about what happenedI did not speak with the doctorNot sure

5. Did Anyone Else Describe What Caused Harm to the Patient? *Select one.Yes, I received a complete explanation from other staffThe explanation was incompleteDifferent providers gave conflicting explanationsThe explanation minimized the seriousness of the eventNo explanation was provided

6. How Were Your Questions Answered? *Select the answer that best describes your overall experience.Yes, all or nearly all my questions were answeredSome questions were answeredThe answers were vague or evasiveStaff repeatedly referred me to someone elseStaff discouraged or prevented me from asking questionsMy questions were ignoredI did not ask questions

7. Did Hospital Staff Apologize to the Patient or Family? *Select one.Yes, and the apology acknowledged what happenedYes, but the person expressed regret without acknowledging what happenedNo apology was offered

8. Did the Doctor or Other Hospital Staff Express Compassion? *Select one.Yes, clearly and consistentlyStaff appeared indifferent or dismissiveStaff blamed the patient or familyNo

9. When You Sought Answers Did Evasiveness Occur? *Select all that apply.Calls, letters, or messages were not returnedMeetings or conversations were repeatedly delayedStaff refused to discuss what happenedI was given vague, incomplete, or changing explanationsThe event was described as unavoidable without further explanationThe patient or family was blamedAccess to records or other information was delayedI felt pressured to stop asking questions

10. Did the Hospital Explain What It Would Do to Prevent a Similar Event in the Future? *Select one.Yes, it explained specific corrective actionsThe hospital said it would investigate but provided no resultsThe hospital said that any changes or investigation results were confidentialNo preventive actions were explainedThe hospital denied that any changes were needed

In Your Own Words *