Inpatient Service Assessment

Inpatient Service Assessment

Validation of service excellence for physicians in an inpatient setting. Form Preview
  • Inpt Service Assessment

    • Provider Info  
    • Patient Info  
    • Patient History  
    •   Yes No N/A
      Reviewed chart prior to entering room
      Displayed knowledge of patient's history, including tests/procedures done during current stay
      Addressed anxiety about medication changes
      Took responsibility for coordinating with PCP/ Consultants
    • Team Dynamics  
    •   Yes No N/A
      Managed Up Resident
      Explained role of Resident
      Introduced Med Student
      Did not cast doubt or pass blame on other caregivers or processes
    • Whiteboard  
    •   Yes No N/A
      Wrote/Pointed to Name
      Wrote Plan of Care
      Wrote Expected Discharge
      Used Pain Scale
    • Provider Communication  
    •   Yes No N/A
      SMALL TALK-Made small talk at beginning
      INTRO-Introduced themselves beyond their name
      INTRO-Gave patient business card
      INTRO-Explained role
      BODY-Consistent eye contact
      BODY-Sat leaning forward toward patient when not examining
      BODY-Leaned onto bed rail when standing
      BODY-Arms not crossed
      BODY-Smiled as appropriate
      VOICE-Appropriate tone
      STANDARD QUESTIONS-Let patient know that they will be asking a series of questions
      VISUAL QUEUES-Noticed when patient not comprehending and reworded
      VISUAL QUEUES-Stopped to ask for questions when discussion became complex
      LISTENING-Did not interrupt patient
      LISTENING-Asked what questions patient had (Open ended)
      LISTENING-Nodded head while patient speaking
      LISTENING-Allowed silence before responding to patient
      EXPLAINING-Walked patient through diagnosis/prognosis/procedure in 'journey-like' manner
      EXPLAINING-Used whiteboard to visualize
      EXPLAINING-Avoided complex jargon
      EXPLAINING-Questions were answered to patient's satisfaction
      EXPLAINING-Explained discharge process and expected time
      EMPATHY-Displayed Empathy
      PACE-Visit did not appear rushed
    • Durations  
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    • Improvement Plan  
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    • Should be Empty: