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No signup required · 9 questions · Patient discharge feedback survey
Patient Discharge TemplateFree

Free Patient Discharge
Survey Template

9 questions on discharge instructions, medication clarity, confidence going home, and follow-up arrangements. The feedback that sits between a safe discharge and an avoidable readmission.

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No signup required · Free forever · Ready in 60 seconds

24-48h
Best window to send after discharge for honest recall
Q2
Confidence going home: the strongest predictor of 30-day readmission
Q7
Concerns addressed before leaving: a key patient safety indicator
WM
CN
QI

Built for ward managers, CNs and quality improvement teams

Patient Experience Survey
How was your discharge from hospital?
9 questions · Anonymous · Takes about 3 minutes
1 of 9
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100% anonymous
No patient login needed
Readmission risk indicators
Live results dashboard
Up to 100 responses free
Template Questions

All 9 Discharge Survey Questions

Nine questions focused specifically on the discharge experience, not the overall hospital stay. That distinction matters. A patient can have an excellent clinical experience and still leave confused about their medications or unsure who to call if something goes wrong. This template captures those gaps before they turn into readmissions.

Question 2 (confidence going home) is the most important readmission predictor. Question 7 (concerns addressed before leaving) is your key patient safety indicator. Both should go into your clinical governance dashboard.

📋 NHS note: This template is a supplementary discharge survey, not a substitute for the Friends and Family Test. Run both: the FFT for compliance, and this template for actionable discharge quality data. Response rates drop below 20% after 72 hours, so send within 24 to 48 hours of discharge.
01How clearly were your discharge instructions explained before you left hospital?Scale 1–5
02How confident do you feel about managing your care and recovery at home?Scale 1–5
03How clearly were your medications and how to take them explained to you?Scale 1–5
04How well were your follow-up appointments or referrals arranged before you left?Scale 1–5
05How well did staff support you with transport, equipment, or care at home arrangements?Scale 1–5
06How would you rate the overall quality of care you received during your stay?Scale 1–5
07Were all your questions and concerns properly addressed before you left?Scale 1–5
08How likely are you to recommend this ward or hospital to family or friends?NPS 0–10
09Is there anything specific about your discharge that we could have handled better?Open Text
What This Survey Measures

Three Areas of Discharge Quality

📋
Information
Discharge instructions, medication clarity, and what to do if things go wrong. Questions 1, 3. The foundation of safe discharge.
🏠
Readiness
Confidence going home, follow-up arrangements, and care logistics. Questions 2, 4, 5. The primary readmission predictors.
🛡️
Safety
Concerns addressed before leaving and overall care quality. Questions 6, 7. The clinical governance dimensions.
How It Works

Simple to Deploy, Immediately Actionable

1
Use This Template
Add your ward or hospital name. Send the link via text within 24 to 48 hours of discharge.
2
Review by ward
Dashboard shows scores by question. Q2 and Q7 are your primary safety signals to monitor monthly.
3
Close the loop
Share results in ward meetings. Present to clinical governance with specific improvement actions. Resurvey at 90 days.
Sample Results

Your Discharge Quality Dashboard

After 88 patients responded following discharge from a general medical ward, the medication explanation and transport support scores were the clear gaps. A pharmacist-led discharge medication review introduced the following month lifted Q3 scores by 0.9 points over the next quarter:

Patient Discharge Survey · 88 responsesGeneral Medical Ward · Q1 2026
Confident going home
Instructions clear
Recommend
Discharge instructions clear3.9 / 5
Confident going home3.7 / 5
Medications explained3.1 / 5
Follow-up arranged4.2 / 5
Concerns addressed3.8 / 5
Q1 24Q2 24Q3 24Q4 24Q1 25Now
🔒
Track discharge quality quarter by quarter
See whether scores improve after process changes. CSV export for clinical governance reports and board papers.
Unlock with Pro — $19/month
FAQ

Frequently Asked Questions

Is this patient discharge survey template free?
Yes. Free forever with no signup from you or your patients. Up to 100 responses free. Pro ($19/month) allows 10,000 responses and ward-by-ward trend tracking.
How is this different from a general patient satisfaction survey?
A general patient satisfaction survey covers the whole admission: communication, treatment, environment, and staff attitudes. This template focuses specifically on the discharge process: instruction clarity, medication explanation, confidence going home, and follow-up arrangements. These are the factors that most directly affect whether a patient recovers well at home or comes back in within 30 days.
Can NHS trusts use this for Friends and Family Test purposes?
This is a supplementary discharge survey, not a substitute for the mandatory FFT. Run both: the FFT for compliance, this template for actionable discharge quality data. The two questions cover similar ground but this template gives you the dimension detail needed to improve specific processes.
When should we send this survey?
Within 24 to 48 hours of discharge. Response rates are 35 to 50 percent in that window and drop to under 20 percent after 72 hours. Send via text message to the mobile number recorded on admission. For patients without a mobile number, a paper version using this framework can be handed out at discharge.
What is a 30-day readmission and how does this survey help?
A 30-day readmission is when a patient returns to hospital within 30 days of discharge, often due to inadequate discharge planning or unclear home care instructions. Question 2 (confidence going home) and Question 3 (medications explained) are the strongest predictors. Improving scores on both through better discharge processes is one of the most effective ways to reduce avoidable readmissions.
Should this survey be anonymous?
Yes for general discharge quality data. Anonymous surveys produce more candid feedback about gaps in instructions or arrangements. For cases where you want to follow up on specific concerns, non-anonymous mode allows optional contact collection with patient consent. Never link negative responses to identifiable patients without their explicit consent.
Can carers complete this on behalf of the patient?
Yes. For patients unable to complete it themselves, a carer or family member can respond on their behalf. This is particularly important for elderly patients, those with dementia, and paediatric patients whose parents are often best placed to assess whether discharge arrangements were adequate.
Can community and intermediate care services use this?
Yes. The template works for acute wards, community hospitals, day surgery, intermediate care, and rehabilitation units. Adjust the introduction to match your setting and replace "hospital" with your service name as appropriate.

Catch the gaps before patients go home

9 questions. Safe discharge evidence. Clinical governance ready.

Use This Template — Free

No signup required · Free up to 100 responses · Pro from $19/month