Inpatients/discharged inpatients during COVID-19 survey

Which site is your feedback about? [REQUIRED]

If you chose "other", please provide details of which site your feedback relates to

What type of service is your feedback about? [REQUIRED]

Which ward, department or service is your feedback about? [REQUIRED]

Was COVID-19 the reason for your admission to hospital?

Yes
No
No - but I developed COVID-19 during my stay
Don't know/can't remember

Overall, how was your experience of our hospital?

What did we do well?

What could we improve?

Did you feel safe whilst you were in hospital?

Yes definitely
Yes to some extent
No

Please give further details about how safe you felt in hospital

Were you kept informed of what was happening at all stages during your stay?

Yes definitely
Yes to some extent
No

Was communication with hospital staff affected by you and/or staff wearing personal protective equipment? (this includes face masks, visors etc)

Yes it was a lot harder to communicate
Yes it was slightly harder to communicate
No it didn’t really make any difference
Don’t know

During your time in hospital did you feel well looked after by hospital staff?

Yes always
Yes sometimes
No

Did hospital staff help you to stay connected with friends and family during your stay?

Yes definitely
Yes to some extent
No
I did not need help

Please give further details about how staff helped you stay connected with friends and family during your stay

Visiting has been suspended across our hospital sites due to the COVID-19 pandemic; what impact did that have on you during your hospital stay?

Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?

Yes
No
No I already knew
I have not yet been discharged

Is there anything else you would like to tell us about your experience?

Which of the following best describes your gender?

Female
Male
Prefer not to say
Prefer to self-describe

If you chose "prefer to self-describe", please tell us how you describe your gender:

Do you identify as transgender?

Yes
No
Prefer not to say

What is your sexual orientation?

If you chose "prefer to self-describe", please tell us how you describe your sexual orientation:

To which of these ethnic groups would you say you belong to?

Do you have any of the following longstanding conditions? (Please select all that apply)

What is your age group?

Would you be happy to share your story/experience of your time in our hospital(s) during the COVID-19 pandemic for the below reasons? Please select any that you consent to:

To be shared with Trust colleagues as part of a 'thank you' for our staff's efforts during pandemic
To be featured on the Trust's social media channels and shared publically
To use on the Trust's internal communications channels - for example in our newspaper or on our staff intranet
To be featured in local/national media

Your name

Your email address

Your telephone number

Inpatients/discharged inpatients during COVID-19 survey

Thinking about being cared for in hospital during the COVID-19 pandemic situation:

About you