Q01
メッセージ
すべてのテンプレートHealthcare & Clinical
Patient Discharge & Medical Release Experience Survey
Captures how clearly patients understood their discharge instructions, medications, and follow-up care after being released from a hospital, ER, or outpatient procedure. An AI follow-up interview digs into the specific point where instructions were unclear, so care teams can fix the discharge process before it causes a readmission or complication.
設問の例
テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。
全13問・約7分
Q02
選択式必須
What type of visit were you discharged from?
- Emergency room
- Inpatient hospital stay
- Outpatient surgery or procedure
- Urgent care
- Other
Q03
選択式必須
Did you receive written discharge instructions before you left?
- Yes, complete written instructions
- Yes, but they were incomplete or hard to read
- No written instructions, verbal only
- I don't remember
Q04
マトリクス必須
Thinking about your discharge conversation, how much do you agree with each statement?
5行 × 5列
- The staff explained my diagnosis or reason for the visit in terms I understood
- I understood which medications to take, stop, or change
- I understood the warning signs that would mean I should seek care again
- I knew who to call if I had questions after leaving
- I had enough time to ask questions before I left
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
選択式必須
Was a follow-up appointment scheduled or clearly arranged before you left?
- Yes, scheduled before I left
- Yes, but I had to schedule it myself afterward
- No follow-up was needed
- I'm not sure if one was arranged
Q06
オピニオンスケール必須
How confident did you feel about managing your recovery or condition at home right after discharge?
スケール: 0 – 10
最小:Not at all confident最大:Completely confident
Q07
評価スケール
How would you rate the overall clarity of your medication instructions specifically?
範囲: 1 – 5
最小:Very unclear最大:Very clear
Q08
選択式必須
In the 7 days after leaving, did you have to call the office, visit an ER, or get readmitted because something about the discharge instructions was unclear or wrong?
- No, everything was clear and went fine
- I called with a question but didn't need further care
- I sought additional care (ER visit, urgent care, or readmission)
- Not applicable / no issues arose yet
Q09
AIインタビュー
Reconstruct exactly what happened after the respondent left care: identify the single instruction (medication, activity restriction, warning sign, or follow-up step) that was least clear to them, ask what they actually did when they hit that confusion, and whether it led them to call the office, guess, ignore it, or seek additional care. If they said everything was clear, probe one specific detail (like a medication dose or a warning sign) to verify true understanding rather than general satisfaction. If they sought additional care afterward, get the specific timeline and root cause.
Q10
自由回答（長文）
Is there anything about the discharge process you'd want us to change for the next patient?
Q11
選択式
What is your age range?
- 18-29
- 30-44
- 45-59
- 60-74
- 75+
- Prefer not to say
Q12
選択式
What is your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
メッセージ
Thank you for sharing your experience. Your responses go directly to our care quality team and help us improve discharge instructions and follow-up support for future patients.
含まれる機能
AIによる深掘り
自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。
注意確認設問
急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。
AIが作成する設問文
文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。
自動レポート
回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。
このテンプレートを選ぶ理由
このテンプレートの設計意図をご紹介します。ほかのアンケートツールには、直接比較できるテンプレートが見つかりませんでした。
ここが違う
- Includes an AI follow-up interview that reconstructs exactly what happened after discharge and pinpoints the specific moment instructions became unclear, rather than only capturing a static rating
- Combines structured questions (visit type, written instructions received, follow-up appointment status, medication clarity rating, post-discharge ER/office contact) with an open-ended change request, giving both quantifiable and narrative data
- Uses a matrix question to assess agreement across multiple discharge-conversation statements plus an opinion scale for at-home recovery confidence, capturing nuance a single Likert item would miss
- Closes with a transparent message telling respondents their answers go directly to the care quality team, and separately collects age range and gender for segmentation without mixing demographics into the clinical questions
よくあるご質問
「Patient Discharge & Medical Release Experience Survey」テンプレートにはどのような設問が含まれていますか？
すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to tell us about your recent discharge or release from our care. Your honest feedback he…」・「What type of visit were you discharged from?」・「Did you receive written discharge instructions before you left?」。すべての設問は上でプレビューでき、自由に編集できます。
このアンケートの回答にはどのくらい時間がかかりますか？
回答者は通常、13問を約7分で回答し終えます。
テンプレートは編集できますか？
はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。
このテンプレートは無料で使えますか？
はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。
公開の準備はできましたか？
このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。
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