Acute Care Treatment Selection Survey Form

Acute Care Treatment Selection Survey Form
Acute Care Treatment Selection Survey Form
What is your professional role?
Which acute care setting do you primarily work in?
Please select the acute care treatment you most frequently choose for patients with acute conditions.
Other (please specify)
What is the primary factor influencing your selection of acute care treatment?
Other (please specify)
Please rate the following factors in terms of their importance when selecting acute care treatment options.
Rows Not Important Somewhat Important Very Important
Evidence from Clinical Trials
Patient Preferences
Speed of Action
Side Effect Profile
Cost/Insurance Coverage
How confident are you in your ability to select the most appropriate acute care treatment?

1
2
3
4
5
1 is Not confident, 5 is Extremely confident
How often do you consult clinical guidelines before selecting an acute care treatment?
What barriers, if any, do you encounter when selecting acute care treatments?
Other (please specify)
Please rate your overall satisfaction with the current process for selecting acute care treatments.
Please share any additional comments or suggestions regarding acute care treatment selection.
Should be Empty:

Select theme:

Rows	Not Important	Somewhat Important	Very Important
Evidence from Clinical Trials
Patient Preferences
Speed of Action
Side Effect Profile
Cost/Insurance Coverage