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Post-discharge survey template

Send patients home ready, and sure of who to call

Four questions for two to three days after patients go home: how clear the discharge instructions were, whether they know who to contact, whether anything has gone wrong and what would have helped. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this post-discharge survey tells you

A post-discharge survey checks the handover from the hospital to home. This template asks four questions in under a minute: how clear the discharge instructions were, whether patients know who to contact if something changes, whether they have had problems since going home and what would have helped in the first days.

It is written for two to three days after discharge, sent by Usertick email to the patients who went home that week, once they have tried to follow the instructions on their own. The same survey runs as a link in your own follow-up emails or as a QR code printed on the discharge papers.

Results shows the average clarity rating with the share of 4s and 5s, and the share who said yes to each of the two yes or no questions. The written answer is read as it arrives and filed under a category such as staff and communication or care and treatment, with a type and an urgency, so an answer that needs a call back stands out in the inbox.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
About a minute
Written for
Two to three days after discharge, by email or the discharge papers
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Stars

How clear were your discharge instructions?

Why ask it
Discharge instructions are written for the patient to follow alone, so their clarity shapes how the first days at home go. A 5-point rating from very unclear to very clear is quick to answer inside the email.
What you learn
The average, a bar per rating and the share who rated 4 or 5, against the period before. Select the 1s and 2s to read what those patients say would have helped.
Make it yours
When clarity drops, give the instructions to someone outside the ward to read and rewrite the parts they stumble on.
Question 2 of 4 · Yes / No

Do you know who to contact if something changes?

Why ask it
A patient who doesn't know who to call when something changes may wait too long or go back to the emergency department. A yes or no makes the gap easy to count.
What you learn
The share that said yes, compared with the period before.
Make it yours
When the share is low, print one phone number at the top of the discharge papers, then watch this share in the next period.
Question 3 of 4 · Yes / No

Have you had any problems since going home?

Why ask it
A Yes is the signal to call the patient, whatever the problem is about, from equipment to a missed appointment. The question stays yes or no, so patients don't have to describe their health to answer it.
What you learn
The share that said yes, against the period before. Select Yes to narrow the page to those patients and read what they say would have helped.
Make it yours
On every plan, a workflow can notify the discharge team for every Yes, so someone calls the patient the same day.
Question 4 of 4 · Text · Optional

What would have helped in your first days at home?

Why ask it
The last question asks what would have made the first days easier, which turns problems into changes to the discharge process, such as a call the next day or a clearer list of who to contact.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a complaint, an idea or praise and flags the urgent ones.
Make it yours
Use the placeholder to point to the discharge process, such as instructions, equipment and appointments, and to ask patients to leave out their condition.

What the answers show

Results turns each question into numbers you can follow week by week.

How clear were your discharge instructions?

The average rating and the share who gave 4 or 5 stars, against the period before.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick After discharge in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Say the survey isn't for emergencies

    Add a message screen at the start that tells patients to call their care team or emergency services for anything urgent, since your team may not read an answer the moment it arrives.

  2. 02

    Call every Yes

    Give each response with a Yes on question 3 an owner in the inbox, and change its status once the patient has been called.

  3. 03

    Send once patients have settled

    Two to three days at home is long enough to try the instructions and short enough to remember the discharge. Schedule the send from Usertick, since it doesn't send on its own when a patient is discharged.

  4. 04

    Keep conditions out of the answers

    Ask about the instructions, the contacts and the first days, never about the illness or the treatment. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

Customer supportPatient satisfaction surveysEmail surveysHospital stay and discharge questions

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Questions from the library

Browse the question library
  1. How would you rate your hospital stay?Stars · Hospital stay and discharge
  2. Rate the hospital on eachMatrix · Hospital stay and discharge
  3. Did you understand your discharge instructions?Yes / No · Hospital stay and discharge
  4. How much progress have you made since your first session?Big scale · Physical therapy
  5. Do you know what to do between sessions?Yes / No · Physical therapy
  6. How often do you do your exercises at home?Multiple choice · Physical therapy

Frequently asked questions

Two to three days after the patient goes home. Usertick sends email now or at a time you schedule up to 30 days ahead, so you can set up each week's discharges in one go.

The patient, or the family member who looks after them at home when the patient can't answer. Add them to your contacts with a CSV import of an email and a name per line.

Call them. Select Yes on the third question to see every patient who said so, give each response an owner in the inbox, and read what they say would have helped.

Ask them not to rely on it. Your team reads answers when it opens the inbox, so add a message screen that points patients to their care team or emergency services for anything urgent.

No. Usertick's terms don't allow health records or medical details in surveys and Usertick doesn't sign business associate agreements, so the questions stay on the instructions, the contacts and the first days at home.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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