Harms to Patients Survey

Harms to Patients Survey2018-11-12T20:53:57+00:00

Service*
- Acute Care Surgery
- BEST
- General Surgery
- Pediatric Surgery
- Surgical Oncology
- Transplant Surgery
- Urology
- Vascular Surgery
Provider Type of Survey Respondent*
- Advanced Nurse Practitioner
- Attending Physician
- Physician Assistant
- Physician Fellow
- Resident Physician
- Other
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)*
- 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*

	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.

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