Quality Improvement Organ

Quality Improvement Survey Organ

The Arkansas Regional Organ Recovery Agency appreciates your input and involvement with us in the donation process. Your perceptions are important to us in maintaining quality service. Your comments will also help us to meet your needs. Please complete the following questionnaire.

* Date:

* Donor Name

ARORA Referral Number

Your Name (Optional)

* Hospital

* Hospital Unit

Email Address (Optional)

* Did the ARORA Personnel:

	Yes	No	Not Obsereved
Respond to your initial telephone referral in a timely manner?
Arrive at the hospital in a satisfactory amount of time?
Conduct themselves in a professional manner?
Introduce other coordinators, surgeons, and assistants as appropriate?
Treat the Donor with respect?
Assist with procedures at the bedside?
Communicate clearly?

* Please rate the following aspects of our service.

* Could the Organ Donation Process be Improved?

Yes

No

If yes, please explain:

0/255 characters

Additional Comments

Suggestions for improvement in services:

* Indicates Response Required

	Very Good	Good	Fair	Bad	Very Bad
Overall appraisal of the donation process?
Was the donation process efficient and coordinated?