Post-Discharge Follow-up Survey
48 hours after discharge: instructions understood, medications collected, warning signs known.
5 questions · 1 page · about 2 minutes to answer · fully editable after you start
Readmissions are often failures of the handover, not the treatment. This 48-hour follow-up checks the three things that keep patients out of the emergency department: whether discharge instructions were understood, whether medications were actually collected and started, and whether the patient knows which warning signs mean call now.
Send it from the Collect tab as an email invitation, so each answer is tied to the patient it went to, and route any No answer to your follow-up call list the same day. The survey costs the patient two minutes; the readmission it prevents costs considerably more.
Replace [local emergency number, e.g. 000] and [local crisis line, e.g. Lifeline on 13 11 14] in its opening note with the services where your respondents live, before you share it: the numbers shown are Australia's. The Collect tab lists both until they are changed.
Template preview
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Page 1
After your discharge
This short survey checks how you are getting on since you left the hospital. It helps us make sure you have what you need to recover safely at home. It takes about 2 minutes.
This form is not an emergency service. If you need urgent medical help or are in immediate danger, call [local emergency number, e.g. 000]. For crisis support, call [local crisis line, e.g. Lifeline on 13 11 14].
Q1.How well do you understand your discharge instructions?*
- Completely
- Mostly
- Parts are unclear
- I do not understand them
Q2.Have you collected and started your prescribed medications?*
- Yes
- Collected but not started
- Not collected yet
- No medications were prescribed
Q3.Do you know which symptoms mean you should contact us immediately?*
- Yes, clearly
- Roughly
- No
Q4.How is your pain or discomfort right now?
Q5.Any questions or concerns since going home?
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