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Emergency department survey template

Hear what the visit was like, once patients are back home

Three questions for two days after an emergency visit: how long patients waited to be seen, how well they were kept informed and treated, and anything else you should know. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this emergency department survey tells you

An emergency department survey asks patients about the visit around their care: the wait before anyone saw them, being kept informed, being treated with respect, their comfort and how clearly next steps were explained. This template asks three questions in about a minute, and every question stays on how the visit was run.

It is written for two days after discharge, sent by Usertick email to patients whose visit has ended, when they are home and able to think back. The same survey runs as a link in your own discharge emails or as a QR code on the discharge papers.

Results shows the share of each waiting band and a heat map of the four parts of the visit with row averages. The written answer is read as it arrives and filed under a category such as waiting times or staff and communication, with a type and an urgency, so a serious complaint stands out in the inbox the day it comes in.

In an emailAs a linkOn your websiteAs a conversation
Questions
3
Time to answer
About a minute
Written for
Two days after discharge, by email or the link on 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 3 questions, one by one

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

Question 1 of 3 · Multiple choice

How long did you wait before you were first seen?

Why ask it
The wait before anyone sees them is what patients remember most about an emergency visit, and it colors every other answer. Bands from under 15 minutes to more than 4 hours match how people recall a long wait.
What you learn
A donut with the share and count of each band, and the stacked shares over time, so a busy month shows up as a growing share of the longer waits.
Make it yours
Select More than 4 hours to see how those patients rated being kept informed, the row a long wait tests most.
Question 2 of 3 · Matrix · Optional

How would you rate the following?

Why ask it
Four rows cover what staff can control even on a busy shift: keeping patients informed, treating them with respect, managing their pain and comfort, and explaining next steps before they leave.
What you learn
A heat map per row with row averages, so a gap such as high marks for respect and low marks for keeping you informed points to one change.
Make it yours
Add a Not applicable column, which Results leaves out of the averages, for patients who were seen and sent home quickly.
Question 3 of 3 · Text · Optional

Is there anything we should know about your visit?

Why ask it
One open question leaves room for what the bands and rows missed, from the waiting room to parking, without asking patients to say why they came in.
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
On every plan, a workflow can post every response that becomes urgent to Slack or Microsoft Teams, so the patient experience lead sees it the same day.

What the answers show

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

How long did you wait before you were first seen?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

How would you rate the following?

Each row's answers side by side, so the part that needs work stands out.

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 Emergency visit 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

    Wait until patients are home

    Two days after discharge gives patients time to rest. Schedule the send for the morning, and Usertick delivers it then.

  2. 02

    Keep the survey on the visit

    Ask about the wait, the information and the respect patients were shown, never the reason they came. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

  3. 03

    Read every urgent answer

    Give each urgent response an owner and a status in the inbox, and note what was done, so serious complaints never wait for a monthly review.

  4. 04

    Send leads a monthly report

    From Pro, a scheduled PDF report sends a dashboard with the waiting bands and the heat map to the department leads each month.

CSAT surveysPatient satisfaction surveysEmail surveysInsurance approvals questions

More satisfaction templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

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CSATAppointment experienceLearn how patients experienced a visit, from booking and waiting to how clearly things were explained and what happens next. Send it the same day, and keep it free of medical details.
CSATPharmacy visitLearn how customers rated a pharmacy visit, the wait and how clearly the medicine was explained. Share it on the receipt with a QR code.
CSATDental visitLearn how patients rated their dental visit, from comfort in the chair to how clearly costs were explained. Send it the same day.
CSATPhysical therapy sessionCheck how patients feel after a session and whether their home exercises and treatment plan are clear. Send it an hour after each session.

Questions from the library

Browse the question library
  1. How easy was it to get approval before your treatment?Customer effort · Insurance approvals
  2. How many days did the approval take?Ruler · Insurance approvals
  3. Was your first request approved?Yes / No · Insurance approvals
  4. How many hours were you there in total?Ruler · Urgent care visits
  5. How did you decide to come in?Multiple choice · Urgent care visits
  6. Were you told how long the wait would be?Yes / No · Urgent care visits

Frequently asked questions

Two days after discharge, when patients are home and can think back on the visit. Usertick sends the email now or at a time you schedule up to 30 days ahead.

Patients who just had an emergency visit have little patience for a long survey. Three questions take about a minute and still cover the wait, four parts of the visit and anything else they want to say.

Read it the day it arrives, give it an owner in the inbox and call the patient back. The urgency reading puts those answers in front of you first.

Yes, by link or QR code: turn on anonymous responses and print the QR code on the discharge papers. A survey sent through Usertick email stays tied to each patient's contact.

No. Usertick's terms don't allow medical details in surveys, so the questions ask about the wait and how the visit was run, and the placeholder of the open question can ask patients to leave out their condition.

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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