ANAESDOCTORS

Paediatric Patient

paediatric patient | ANAESDOCTORS

Thank you for completing this survey on behalf of your child. The purpose of this survey is to help the anaesthetist improve their service.

Your feedback is confidential. All information is de-identified before being provided to the relevant anaesthetist.

Name

Gender

Age

Date of Surgery DD/MM/YY

Please use the scale of N/A (not appropriate), 1 (poor) to 5 (excellent) where appropriate

1. Communication between anaesthetist and parents

The anaesthetist listened carefully to you as the parent.

1 poor 2 3 4 5 excellent 1a. Please select

The anaesthetist explained things to you in a way that was easy to understand.

1 poor 2 3 4 5 excellent 1b. Please select

The anaesthetist treated you with courtesy and respect.

1 poor 2 3 4 5 excellent 1c. Please select

2. Communication between anaesthetist and child

The anaesthetist listened carefully to your child.

Not appropriate 1 poor 2 3 4 5 excellent 2a. Please select

The anaesthetist talked an acted in a way that was appropriate for your child's age.

Not appropriate 1 poor 2 3 4 5 excellent 2b. Please select

The anaesthetist talked and acted in a way what was appropriate to your child's age.

Not appropriate 1 poor 2 3 4 5 excellent 2c. Please select

The anaesthetist encouraged your child to ask questions.

Not appropriate 1 poor 2 3 4 5 excellent 2d. Please select

3. Involving teens in their care

The anaesthetist involved your teenager in discussion of his care.

Not appropriate 1 poor 2 3 4 5 excellent 3a. Please select

4. Privacy

The anaesthetist took effort to ensure privacy when talking with parent/s and child.

1 poor 2 3 4 5 excellent 4a. Please select

5. Anxiety

Was your child anxious before surgery?

Yes No 5a. Please select

The anaesthetist's effort to minimise your child's anxiety or fear.

Not appropriate 1 poor 2 3 4 5 excellent 5b. Please select

6. Pain

Did your child have pain after surgery?

Yes No 6a. Please select

Management of your child's pain after surgery.

Not appropriate 1 poor 2 3 4 5 excellent 6b. Please select

7. Nausea and vomiting

Did your child have nausea or vomiting after surgery?

Yes No 7a. Please select

Management of your child's nausea and vomiting after surgery.

Not appropriate 1 poor 2 3 4 5 excellent 7b. Please select

8. After care

The anaesthetist informed you personally if there was a problem during anaesthesia?

Not appropriate Yes No 8a. Please select

Information from the anaesthetist about what to expect and how to care for your child after surgery.

Not appropriate 1 poor 2 3 4 5 excellent 8b. Please select

9. Comments - Please tell us if you had any positive or negative experience:

9. Details

10. Suggestions for improvements - Please tell us how the care of your child can be improved:

10. Details

11. Willingness to have the same anaesthetist

If your child were to have another anaesthetic, would you be happy to have the same anaesthetist?

Yes No 11. Please select

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