Case Studies

Intermediate Cardiac Care Unit (ICCU)

Using the selected specific aim of the ICCU concerning the timeliness of assigning patients to beds, the lead improvement team created a fishbone to identify the reasons why the admissions department could not get a bed for a new admission within thirty minutes of the initial phone call (see Figure 19.5).

FIGURE 19.5. FISHBONE DIAGRAM FOR ICCU BED ASSIGNMENT.

Physical Environment

People

Physical Environment

People

Transportation

Process

Patients

Not enough to do the work Other dept. delays

Waiting to talk to MD

Waiting for education

Not adhering to process

Transportation

Process

Patients

Note: VN = visiting nurse.

Plastic Surgery Section

The lead improvement team created a cause and effect diagram showing the causes of the backlog of appointments keeping patients from being seen in a timely manner (see Figure 19.6). The main categories included patients, processes, providers, and support staff.

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