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Hospital Discharge Experience & Readiness Survey

Assesses whether patients left the hospital genuinely prepared to manage recovery at home — covering instruction clarity, medication confidence, and follow-up care arrangements. An AI follow-up interview digs into what actually happened after discharge, especially for patients who needed unplanned care, to surface where the handoff broke down.

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샘플 질문

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질문 12개 · 약 7분
Q01
메시지

Thanks for taking a few minutes to tell us about your recent hospital discharge. Your honest answers help us make the transition home safer and clearer for future patients. Your responses are completely confidential and anonymized. This takes about 4-5 minutes.

Q02
객관식필수

What was the primary reason for your hospital stay?

  • Planned surgery or procedure
  • Emergency or urgent treatment
  • Childbirth
  • Ongoing condition management
Q03
객관식필수

How long ago were you discharged?

  • Today or yesterday
  • 2-7 days ago
  • 1-4 weeks ago
  • More than a month ago
Q04
의견 척도필수

Overall, how prepared did you feel to leave the hospital and manage your recovery at home?

척도: 1 – 10
최소:Not at all prepared최대:Completely prepared
Q05
매트릭스필수

Before you left the hospital, how clearly were each of these covered?

4개 행 × 3개 열
  • Instructions for taking my medications
  • Warning signs that mean I should seek help
  • When and how to schedule follow-up care
  • Who to contact if I have questions after leaving
열: Not covered · Covered but unclear · Covered and clear
Q06
객관식필수

Did hospital staff arrange a follow-up appointment with a doctor before you left?

  • Yes, it was scheduled for me before I left
  • Yes, but I had to schedule it myself afterward
  • No appointment was arranged
  • Not sure
Q07
객관식필수

Since leaving the hospital, have you contacted your doctor's office, gone to urgent care, or returned to the emergency room because something about your discharge care was unclear or didn't go as planned?

  • No, everything went as expected
  • Yes, I contacted my doctor's office
  • Yes, I went to urgent care
  • Yes, I returned to the emergency room
Q08
평점 척도

How would you rate the courtesy and respect shown by the staff who handled your discharge?

범위: 1 – 5
최소:Poor최대:Excellent
Q09
AI 인터뷰

Reconstruct what actually happened after this patient left the hospital, anchoring on their preparedness rating and any items they marked 'unclear' or 'not covered' in the instructions breakdown. If they contacted a doctor, went to urgent care, or returned to the ER, get the specific sequence: what confused them, what they wish had been explained differently, and whether it was preventable with clearer discharge instructions. If they felt fully prepared, ask what specifically made the handoff work well.

Q10
객관식

What is your age range?

  • Under 30
  • 30-44
  • 45-59
  • 60-74
  • 75 or older
  • Prefer not to say
Q11
객관식

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q12
메시지

Thank you for sharing your discharge experience. Your responses will be reviewed by our care team to identify where discharge instructions and follow-up planning can be made clearer and safer for future patients.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • Goes beyond a static checklist by using an AI follow-up interview to reconstruct what actually happened after discharge, especially for patients who needed unplanned care, surfacing exactly where the handoff broke down
  • Combines structured measures (opinion scale on preparedness, a matrix on clarity of pre-discharge instructions, ratings of staff courtesy) with open-ended probing rather than relying on multiple choice alone
  • Directly links discharge process gaps to real-world outcomes by asking whether a follow-up appointment was arranged and whether the patient later needed a doctor, urgent care, or ER visit
  • Produces an automated report from the responses with transparent, reviewable AI prompts, rather than leaving analysis to manual chart review

Jotform

Hospital Discharge Form Template

A static, fillable discharge form built on Jotform's general form builder, aimed at capturing discharge documentation rather than probing patient experience in depth. It's a ready-to-use template but structurally a form, not an interview-style survey. Customization is drag-and-drop with no adaptive questioning.

잘하는 점

  • Quick to deploy and customize using Jotform's widely-used form builder
  • Familiar drag-and-drop interface for editing fields
  • Likely supports standard form logic and integrations typical of Jotform templates

아쉬운 점

  • Static field-based form with no adaptive AI follow-up to probe individual patient answers
  • No mechanism to dig into what happened after discharge for patients who needed unplanned care
  • No published methodology or prompt transparency since it isn't an AI-driven interview tool

SurveySparrow

Free Hospital Discharge Form Template

A conversational-style survey template from SurveySparrow's healthcare template library, offered free. It focuses on chat-like question flow but is still a fixed question set rather than a true adaptive interview. Good for basic discharge feedback collection at no cost.

잘하는 점

  • Conversational UI that can feel more engaging than a plain form
  • Free to use, lowering the barrier to start collecting feedback
  • Part of a broader healthcare template library for related surveys

아쉬운 점

  • No adaptive AI follow-up interview to explore individual patient circumstances beyond preset questions
  • No automated quality scoring of individual responses
  • No voice AI interview option for patients who prefer speaking over typing

Typeform

Hospital Discharge Form Template

A polished, one-question-at-a-time template on Typeform's design-forward platform, well suited for simple discharge data collection. It relies on fixed question logic rather than any AI-driven probing of open-ended answers. Reporting is limited to Typeform's standard response summaries.

잘하는 점

  • Clean, mobile-friendly one-question-at-a-time design
  • Easy for patients to complete quickly
  • Supports basic conditional logic between questions

아쉬운 점

  • No adaptive AI interview to reconstruct what happened post-discharge for patients needing unplanned care
  • No automated per-response quality scoring
  • No guided screen-share task capability, which isn't relevant to this use case but underscores it's a plain survey tool

QuestionPro

Patient Satisfaction Survey Questions + Sample Questionnaire Template

A general hospital patient satisfaction template rather than one built specifically around discharge readiness, so coverage of instruction clarity, medication confidence, and follow-up-care arrangements would need to be added manually. It's a solid broad satisfaction questionnaire from an established survey platform, useful as a starting reference rather than a discharge-specific tool.

잘하는 점

  • Broad, established patient satisfaction question bank covering multiple touchpoints
  • Backed by a mature survey platform with standard reporting and analytics
  • Easy to adapt sample questions for various hospital departments

아쉬운 점

  • Not specifically designed around discharge readiness or post-discharge outcomes
  • No adaptive AI follow-up interview to surface where a discharge handoff broke down
  • No transparent, reviewable AI prompt methodology since it's a static questionnaire

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