Emergency Department Experience: Post-ED Visit Survey

Complete this survey each time your child visits an Emergency Department for treatment of a sickle cell pain crisis. Answer the following questions about your child’s most recent Emergency Department visit. You’ll need to complete a separate survey for each ED visit, so be sure to bookmark this page.

Please note: a hospital Emergency Department is referred to as “ED” throughout the survey.

SCD - NELASCAF Post-ED Visit Survey
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Participant/Child's Information

Child's Name

Parent/Guardian Information

Parent/Guardian's Name

Emergency Department Experience

Had your child been seen at this ED prior to this visit?
Who accompanied your child to the ED?

Using the scale below, have your child rate their pain from 0 to 10 at the time of their ED visit.

Choose the number that corresponds to the image your child selected on the pain scale.
After seeing the doctor, how long did your child wait before receiving their first pain medication?
Did you tell the ED staff the name of your child's regular doctor and/or hematologist?
How responsive was ED staff to the provider information you gave them?
Did you feel “heard” by the ED staff?
Do you feel your child was treated with respect?
Were your child's pain/concerns adequately addressed?
Were you offered the opportunity to speak with a patient advocate?
Did you ask for a patient advocate?
Was your child admitted to the hospital for further treatment?
Was a pain plan discussed during your child's visit?
How would you rate your child's overall ED experience during this visit?
Did you present your child's MedicAlert Smart ID Card to the ED staff?
Does your child have a doctor-prescribed SCD Pain Plan on file with MedicAlert?
From your observation, did the MedicAlert Smart ID card and access to your child's pain plan make a difference in the care your child received?
In your opinion, did presenting your child's MedicAlert Smart ID Card improve or worsen your child's ED experience, compared to past visits without the MedicAlert ID?
Do you see value in having your child continue to carry the MedicAlert Smart Card with them?
Would you recommend a MedicAlert Smart Medical ID Card to family members or other people living with SCD?

Thank you for providing this important information to establish the efficacy of this program. 

If you have any questions about the pilot or how to complete the survey, please contact the program administrator at nelapilot@medicalert.org.