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Please review your experience of your visit to the Endoscopy Department by completing the following survey.

Please ensure that you answer all the questions and submit the questionnaire.

Please tick relevant boxes.

Note: Due to the anonymous nature of this questionnaire, we will not be able to remove your responses once submitted as we will be unable to link any feedback to specific individuals.

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* 1. Which site was your procedure carried out on?

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* 2. What procedure did you have?

Before your procedure date

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* 3. Were you offered a choice of dates/times to have the test?

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* 4. Did you receive written information about what the test involved and what to expect?

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* 5. If you were called before your procedure by the nursing team how did you rate this experience?

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* 6. Overall, was the information provided before your procedure helpful?

Arrival at the Hospital

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* 7. Were you able to locate the endoscopy unit easily upon arrival at the hospital?

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* 8. At the Endoscopy Unit reception, were you dealt with promptly and efficiently?

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* 9. Were you and/or your relatives/carers given a clear indication of how long you would be in the department?

The Investigation (Test)

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* 10. Was there a delay before you had your test?

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* 11. If Yes, were you informed of the reason?

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* 12. How would you rate the amount of information given to you by the staff member preparing you for the test?

Privacy and Dignity (Wait Area)

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* 13. Were you given enough privacy when changing or being prepared for your procedure?

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* 14. Did you find your privacy and dignity were respected in the waiting area prior to your test.?

Consent

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* 15. It is important to us that you are asked to consent to your procedure in an appropriate setting. Please tell us where you signed your consent form:

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* 16. Were you made aware of the potential risks/complications associated with doing the test?

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* 17. Were you given an opportunity to ask questions before signing the consent form?

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* 18. Were you made aware of your right to withdraw consent at any time?

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* 19. Were you warned that you may experience pain/discomfort during your procedure?

About the test

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* 20. Did the team (performing your procedure) introduce themselves to you?

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* 21. How would you rate your comfort level during the test?

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* 22. Was the test more or less uncomfortable than you thought it would be?

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* 23. Did you feel that your privacy / dignity were respected during the procedure?

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* 24. How would you rate the team that looked after you during your procedure?

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* 25. Did you feel that your privacy / dignity were respected whilst in recovery?

Test Results and Discharge Information

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* 26. Were you given a copy of your report which was explained to you before discharge?

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* 27. If you have to wait for results (e.g. biopsy results), has it been made clear how these will be given and relevant timescales?

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* 28. Was advice given of what to expect post procedure over the next 24/48hours (e.g. regarding sedation/bloating etc.)?

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* 29. Were you given a telephone number to ring if you needed advice after the test?

Overall Feedback

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* 30. Are there any ways in which your visit to the Endoscopy Unit could have been improved?

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* 31. Is there anything you think the Endoscopy Unit is doing particularly well?

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* 32. How would you rate your overall experience with the Endoscopy Unit?

Thank you for taking the time to answer this questionnaire.

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* 33. Please leave your name and address if you would like feedback on the results.

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