LINE-SORT Clinical Feedback Survey

LINE-SORT Clinical Feedback Survey
Hospital/Facility Name*
Department/Unit*
City, State*
Contact Name & Title*
Email*
Phone Number
Please enter a valid phone number.
Date of Evaluation*

MonthDayYear
Date
Product Use Context
Number of Patients Involved in LINE-SORT Testing:
Care areas where LINE-SORT was used:

ICUEDORTransport/EMSOncologyOther
Average number of IV lines per patient:
Approximate LINE-SORT pads used per patient:
Duration of LINE-SORT use per patient:
Ease of Use & Workflow Impact (1=Strongly Disagree, 5=Strongly Agree)
LINE-SORT was easy to apply and position along IV lines

1

2

3

4

5

1 is Worst, 5 is Best
The pad spacing and flexibility worked well for our setup

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT improved line organization and reduced tangling/confusion

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT helped identify which line corresponded to medication/port

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT reduced time spent tracing or managing lines

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT improved overall bedside workflow efficiency

1

2

3

4

5

1 is Worst, 5 is Best
The foam density, elasticity and quality were appropriate for use

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT remained secure during patient care activites

1

2

3

4

5

1 is Worst, 5 is Best
Clinical Impact (1=Strongly Disagree, 5=Strongly Agree)
Using LINE-SORT improved patient safety and line clarity

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT may help reduce risk of line-related infections/disconnections

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT supported faster response during medication changes/emergencies

1

2

3

4

5

1 is Worst, 5 is Best
LINE-SORT reduced nursing frustration and mental load with multiple lines

1

2

3

4

5

1 is Worst, 5 is Best
How much time would LINE-SORT save you per shift untangling, sorting, tracing and organizing IV lines?
Training & Integration
Training time needed to us LINE-SORT effectively
Used instructional guide or QR training?
Would LINE-SORT require policy/workflow requirements?
If yes, please describe:
Overall Evaluation
How likely are you to recommend LINE-SORT for ongoing use?
Would your department purchase LINE-SORT as standard supply?
Where does your organization purchase from? (Select all that apply)*

McKessonHenry ScheinMedlineCardinal HealthPremierVizientConcordance HealthcareSolutionsOther
Overall performance rating

1

2

3

4

5

1 is Worst, 5 is Best
Open Feedback (benefits, challenges, suggestions)
Evaluator Name/Title
Signature (digital or handwritten)
Date

MonthDayYear
Date
Should be Empty: