Patient Experience Survey (Emergency Room)

Issue this Emergency Room Patient Experience Survey to a patient who had an operation or procedure inside the emergency room of your hospital/clinic. The survey will inform what your hospital/clinic needs to maintain or improve regarding your emergency room(s).

By Matt Olivares on Aug 2, 2025.

Fact Checked by RJ Gumban.

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What is an Emergency Room Patient Experience Survey?

were created in order to get feedback from patients who were received by a hospital emergency department, treated, and discharged after their treatment.

Given that emergency rooms entail urgency, this is also the opportunity for a patient to share their experiences not just with the treatment itself, but with the doctors and nurses who were present for their case.

Feedback from patients is valuable, given they can provide opportunities to see what a hospital’s emergency department is doing well and what they can improve on to enhance patient experiences in the future.

Here at Carepatron, we have an Emergency Room Patient Survey template that you can use for your practice!

Patient Experience Survey (Emergency Room) Template

Patient Experience Survey (Emergency Room) PDF Template

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How to use this Emergency Room Patient Experience Survey

Issue this to your patient.

After a patient is discharged, you may issue this survey to them or their relatives/companions. Have them answer it and mail it back to your hospital/clinic, or emailed it to you if you sent it online.

The patient will answer a survey of moderate length.

All the patient needs to do is answer several questions concerning their short journey in the emergency department. They need to tick one of the checkboxes per question. The questions they will answer are:

Why did you go to/end up in the emergency room?
When you were rushed to the emergency room, were you taken by an ambulance or did someone drive you there?
When you arrived at the emergency department, how long did it take before someone attended to you?
Did you get cared for within 30 minutes upon arriving at the emergency department?
While you were in the emergency room, did the attending doctors/nurses ask you about any medicines you were taking?
By any chance, did attending practitioners give you any medicine, and did they explain what the medicine was for and the possible side effects you might feel?
During your time in the emergency room, were you given any tests? If so, what tests were you given?
Did attending practitioners discuss these tests and results with you?
During your visit, how often did nurses listen to you?
Did these nurses treat you with courtesy and respect?
Did these nurses explain things to you in a way you could understand?
During your visit, how often did the doctor(s) listen to you?
Did the doctor(s) treat you with courtesy and respect?
Did the doctor(s) explain things to you in a way you could understand?
Before being discharged, did attending practitioners prescribe any medicines to you?
Did they explain to you what the medicine’s for?
Did they inform you about any health problems and related symptoms to be on the look out for?
Did they also talk to you about getting follow-up care?
Did they also talk to you about why you should get follow-up care?
Did they talk to you about how to go about getting follow-up care?
From a scale of 0-10 (with 0 being the absolute worst and 10 being the absolute best), how would you rate your overall experience in the emergency room?
Would you recommend this emergency department to others?

The last part is an additional comments box where they can talk about some of their answers and any suggestions they might have.

Have them send the fully-accomplished survey to you.

When issuing this survey, tell the patient to mail it back to you, whether through a postal service, by passing by the hospital/clinic, or via email if you sent it online.

When would you typically use an Emergency Room Patient Experience survey?

You issue this to the patient when discharged and before leaving the hospital. Or, you can send it to them via email. Don’t forget to administer this to every patient (or their companions) after discharge, as it’s best to know how your emergency department is doing.

Obtaining this data from as many patients as possible will allow you to formulate an accurate understanding of patient experience. Ensuring that patient needs are listened to and met is a crucial component of working in the healthcare industry, so consistently distributing this survey is very important.

Who can use this Emergency Room Patient Experience survey?

Anyone working in a hospital/clinic’s emergency department can use this survey. Always remember to hand this to the patient or their companions before they leave the premises. Or email them if that’s more convenient for both you and the patient.

Why is this type of patient experience survey important for emergency departments?

Emergency rooms entail urgency, so knowing how your entire department is doing in terms of how you administer care and treatment to patients is highly important. Patients being there might mean life or death to them, so everyone in your department should know how patients and their relatives/companions perceive the services you provide to people.

What are the benefits of using an emergency room patient experience survey?

To expound on what was previously said, knowing how patients and their relatives/companions perceive the services you provide to people who require emergency care is critical. Your department will likely be the one that stands between patients and poor outcomes, so knowing how well the nurses and doctors are doing their jobs and the state of your department's equipment and facilities is important.

Through feedback, you will be able to determine what great things your department should be doubling down on and know what you need to improve. Do you need to remind your doctors and nurses to be more courteous to patients? Is your facility clean? Is your equipment up to date? These are the kinds of questions you’ll be able to answer, hopefully, after the patient provides you with feedback.

You can also use the Patient Survey Template to gather feedback from clients about their experience and satisfaction with your services. This template helps in identifying areas for improvement and ensures that patient perspectives are considered in enhancing care quality.

Commonly asked questions

The questions that you should ask must benefit your department in terms of how doctors/nurses can improve when it comes to interacting with patients, how quickly the department is able to assign someone to attend to patients, etc. You want to write questions that will lead to points for improvement. If you’re having trouble with that, you can use our template for free! Or use it as inspiration to give you an idea as to what questions you should ask!

That depends. If the patient is not groggy after the treatment, then you may issue this to them. But if they cannot pay attention or even hold anything because they are weak or on medication, you might want to hand it to their companion. If it’s more convenient for both parties, just email it and have them send it back after a while.

You can send a follow-up to nudge them. Try adding “We would like to hear from you so we know what aspects of our services are doing well and what aspects are not” to your follow-up message.

But if they really don’t send one back to you, well, that’s okay. So long as you don’t forget to issue these surveys to patients/their companions, you’ll be fine. Someone is bound to send back fully-accomplished forms.