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View a Sample of The Memory Jogger II - Goal - QPC

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Cause & Effect/Fishbone<br />

Bed Assignment Delay<br />

Resources<br />

Physician did<br />

not write order<br />

Medicine<br />

admit quota<br />

Nursing shortage<br />

Unit clerk staffing<br />

Timing<br />

Patient arrives<br />

too early<br />

Unit clerk training<br />

Transfer too early<br />

from another hospital<br />

Call housekeeping<br />

when clean<br />

Physician misuse –<br />

inpatient<br />

Double rooms<br />

Many<br />

transfers<br />

Specialty beds<br />

Cardiac monitors<br />

Wait for MD<br />

Discharged patient<br />

did not leave<br />

Wait for ride<br />

Wait for lunch<br />

Wait for results<br />

Call housekeeping<br />

too late<br />

Call housekeeping<br />

too early<br />

Think it will take<br />

more time<br />

Too busy<br />

Sandbag<br />

Machine (PCIS)<br />

Admitting unaware<br />

bed is clean<br />

Delayed<br />

entry<br />

Inappropriate<br />

ER admittance<br />

System incorrect<br />

Not entered<br />

Functions not useful<br />

Not used<br />

Shift change<br />

Not told<br />

On break<br />

Need more training<br />

No trust<br />

Not used<br />

pending discharge<br />

Reservation<br />

unaware<br />

Not entered<br />

Patient waits<br />

for bed<br />

Unit switch bed<br />

Unit clerk unaware<br />

<strong>of</strong> discharge or transfer<br />

MD procedures<br />

Hospital procedures Communication<br />

Information provided courtesy <strong>of</strong><br />

Rush-Presbyterian-St. Luke’s Medical Center<br />

©1994 GOAL/<strong>QPC</strong> C & E/Fishbone 29

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