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Harms to Patients Survey
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Harms to Patients Survey
Harms to Patients Survey
2022-06-16T17:43:09+00:00
Harms to Patients Survey
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This survey intends to assess perceptions of handoff-related harms to patients. If you are a rotating clinician, please indicate your current location, department or service and unit where indicated. This survey does not replace a safety event report. If a safety event has occurred, please exit this survey and submit via internal event reporting system.
Hospital or Location
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Please Select
First Choice
Second Choice
Third Choice
Department or Service
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Please Select
Adolescent Medicine
Ambulatory Care
Anesthesiology
Bone Marrow Transplant
Cardiology
Critical Care
Emergency Medicine
Endocrine
Family Medicine
Gastroenterology
Hematology / Oncology
Immunology
Infectious Disease
Internal Medicine
Intermediate Care Unit
Leukemia
Medical/Surgical
Neonatal Intensive Care
Neonatology
Nephrology
Neurology
Obstetrics & Gynecology
Orthopedics
Otolaryngology
PACU
Palliative Care
Pediatric Critical Care
Pediatric Oncology
Pediatrics
Podiatry
Psychiatry
Pulmonary
Radiology
Rheumatology
Sleep Medicine
Surgery
Telemetry Unit
Urology
Other
Other Department or Service
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Unit or Care Area - [Hospital 1]
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Please Select
First Choice
Second Choice
Third Choice
Unit or Care Area - [Hospital 2]
*
Please Select
First Choice
Second Choice
Third Choice
Unit or Care Area - [Hospital 3]
*
Please Select
First Choice
Second Choice
Third Choice
Provider Type of Survey Respondent
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Nurse
Advanced Nurse Practitioner
Physician Assistant
Resident Physician
Physician Fellow
Attending Physician
Respiratory Therapist
Other
Other Survey Respondent
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Over the past month, how often did you receive a problematic handoff? (e.g., information that was clinically important was not given to you, or you received inaccurate information)*
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Never (0 times)
Rarely (1 or 2 times)
Sometimes (between 3 and 5 times)
Often (more than 5 times)
Please keep these definitions in mind when answering the next set of questions.
Minor Harm: Limited clinical consequence—such as a need for more frequent monitoring or transient discomfort, without prolongation of hospitalization, significant organ dysfunction or worsening of clinical condition.
Major Harm: Significant clinical consequences such as deterioration in clinical status, organ dysfunction, prolonged hospitalization, disability beyond discharge, or death.
Harms to Patients
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0
1
2
3
4
>4
Over the past month, please estimate the number of your patients who experienced a MINOR harm as a result of a problematic handoff that you received.
Over the past month, please estimate the number of your patients who experienced a MAJOR harm as a result of a problematic handoff that you received.
Over the past month, how many days did you work?
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Please enter a number from
0
to
31
.
