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ITU Patient and Relatives Survey
Who are you? *
Patient
Relative
Did staff welcome you on your arrival to the unit?
Yes
No
Did Staff respond in a timely manner to your arrival?
Yes
No
On admission were you kept informed by staff members while in the waiting room?
Yes
No
Do you feel that your relative has been receiving the best possible care?
Yes
No
Do you feel satisfied with the frequency you were able to talk to the doctors about your relative’s condition and plan of care?
Yes
No
When explanations about your relative’s condition are discussed with you are they in terms that you have understood?
Yes
No
Do you feel confident that if there is an emergency or a significant change in your relative’s condition someone will contact you?
Yes
No
Do you feel that members of the intensive care team are respectful and supportive of your emotional needs?
Yes
No
Have you found the waiting area comfortable?
Yes
No
Have you found the Intensive Care Unit to be clean and tidy on your visits?
Yes
No
Please use the box below to give any additional comments:
Did you find the intensive care environment where you were treated to be excessively noisy during the day time?
Yes
No
Did you find the intensive care environment where you were treated to be excessively noisy during the night time?
Yes
No
What did you think of the cleanliness of the Intensive Care environment?
Exceptionally clean
Very clean
Clean
Not very clean
Dirty
Did you find that the staff in the intensive care unit worked well together?
Yes
No
Do you feel that the intensive care team have treated you with dignity and respect?
Yes
No
Do you feel that you were involved in making decisions about the care you received?
Yes
No
Do you feel that the intensive care team were respectful and supportive of your emotional needs?
Yes
No
Did you understand why you were being given the care that you have received?
Yes
No
When explanations regarding your condition and the care you received were given, were they in terms that you could understand?
Yes
No
Do you feel satisfied with the frequency that you could speak to the doctors about the care you received?
Satisfied
Not satisfied
NHS hospitals must provide same sex accommodation. How satisfied are you that the intensive care unit achieved this during your stay?
Satisfied
Not satisfied
Please use the box below to give any additional comments:
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Last name *
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