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ED Staff Feedback
Unique ID
Date
(Required)
DD
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MM
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YYYY
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Role
(Required)
Nurse in Charge
EPIC
Nursing staff
PFO
Medical staff
Nursing assistant staff
Rather not say
Other
Please specify your role.
(Required)
Shift covered
(Required)
Day
Late
Night
Area
(Required)
Majors
ECA
Paeds
Escalation doctor
The escalation doctor was in place for:
(Required)
The whole shift
Part of the shift
None of the shift
Please let us know what you thought of the escalation doctor role and if there are any improvements you would like to suggest:
ECA RAT senior decision maker
The ECA RAT senior decision maker was in place for:
(Required)
The whole shift
Part of the shift
None of the shift
Please let us know what you thought of the ECA RAT senior decision maker role and if there are any improvements you would like to suggest:
Specific practitioner to see patients triage category 3+ in ECA
A specific practitioner was in place for:
(Required)
The whole shift
Part of the shift
None of the shift
Please let us know what you thought of the specific practitioner role and if there are any improvements you would like to suggest:
Board Rounds
When did you complete board rounds?
8am
10am
12 noon
2pm
4pm
6pm
8pm
10pm
12 midnight
2am
4am
6am
Please tell us any benefits the shift had from completing a board round every 2 hours (or 4 hours in majors), if you would do anything to improve the board round and if you were unable to complete every 2 hours (or 4 hours in majors), what prevented this?
Safety Brief
The safety brief was completed once during the shift:
(Required)
Yes
No
Please tell us about the safety brief and, if you were unable to complete one during the shift, why was this? Are there any improvements you would like to suggest?
Safety Walk-Around
The safety walk-around was completed during the shift:
(Required)
Yes
No
Please tell us about the safety walk-around and, if you were unable to complete one during the shift, why was this? Are there any improvements you would like to suggest?
Any other comments?
Comments
This field is for validation purposes and should be left unchanged.