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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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" indicates required fields
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 incident report. If a safety event or near miss has occurred, please exit this survey and submit via RL-Datix.
Service or Specialty
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Please Select the Appropriate Service or Specialty
Anesthesiology
Cardiology
Critical Care
Emergency Medicine
Hematology / Oncology
Infectious Disease
Inpatient Nursing
Internal Medicine
Intermediate Care Unit
Medical/Surgical
Neonatal Intensive Care
Neonatology
Nephrology
Neurology
Obstetrics & Gynecology
Orthopedics
Other
Pediatrics
Respiratory Therapy
Surgery
Specific Unit Name
Please Select the Appropriate Unit Name
6 ICU
7A
7B - Stroke/Medical
7E
8A Surg
8B Medical
8E Onc
9ICU - Medical ICU
Case Management
Cath Lab
CTVU/6E
ED
Endoscopy
Dialysis
Inpatient Rehab (IPR)
Inpatient Wound Care
Interventional Radiology
LDR
MCH - Children's Hospital
Newborn Nursery
NICU
OB
PreOp
Recovery
Respiratory Therapy
SICU-A
SICU-B
Surgery
Virtual Nursing
Other Unit
Provider Type of Survey Respondent
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Nurse
Advanced Practice Provider
Attending Physician
Respiratory Therapist
Other
Other Provider
Over the past 7 days, 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 7 days, please estimate the number of your patients who experienced a MINOR harm as a result of a problematic handoff.
Over the past 7 days, please estimate the number of your patients who experienced a MAJOR harm as a result of a problematic handoff.
Over the past 7 days, how many days did you work?
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0
1
2
3
4
5
6
7
