# Situation: A 36-bed orthopedic and ophthalmology ward of a public hospital is staffed by a charge nurse, staff nurses, and nursing attendants. Nursing students from an affiliated college have clinical duty on the ward three days a week. Clients from the ward often wait more than 2 hours for radiology examinations. The charge nurse audits 40 delayed trips and finds the main point of delay in each: - Ward sent the transport request late: 12 - No porter from the patient transport service was free: 13 - Radiology was not ready when the client arrived: 15 Each service says the delay starts in another service. Which action is BEST for a lasting solution?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630555  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 36-bed orthopedic and ophthalmology ward of a public hospital is staffed by a charge nurse, staff nurses, and nursing attendants. Nursing students from an affiliated college have clinical duty on the ward three days a week.

Clients from the ward often wait more than 2 hours for radiology examinations. The charge nurse audits 40 delayed trips and finds the main point of delay in each:
- Ward sent the transport request late: 12
- No porter from the patient transport service was free: 13
- Radiology was not ready when the client arrived: 15
Each service says the delay starts in another service. Which action is BEST for a lasting solution?

## 보기

1. Have ward nurses send transport requests 1 hour earlier than now
2. Ask radiology to confirm the time slot before calling for a client
3. Ask the patient transport service to add one porter each morning
4. Form a working group with members from the three services **✔ 정답**

**정답: 4**

## 해설

The audit shows three causes of similar size, each in a different service, and each service blames the others. A task force or working group with members from all affected services can examine the handoffs together and commit each service to its part. Fixing only the largest single category would still leave most of the delays.

## 심화 해설

Three causes, three services
The charge nurse's audit of 40 delayed radiology trips shows the main point of delay: the ward sent the request late in 12, no porter was free in 13, and radiology was not ready in 15. The three causes are similar in size and each lies in a different service. Each service also says the delay starts elsewhere. A problem whose causes are spread across several services, with each blaming the others, needs a working group with members from all of them. Only a cross-functional team can map the whole process, see how the handoffs interact, and commit each service to its part.

Why single-service fixes fall short
Fixing only one cause leaves most delays in place. Even the largest category, radiology not being ready, accounts for only 15 of 40, so the other 25 would remain. Changes in one service can also shift the problem rather than solve it: if the ward sends requests earlier but radiology is not ready, clients simply wait longer in the corridor.

| Option | Delays addressed | Limitation |
| --- | --- | --- |
| Ward sends requests 1 hour earlier | 12 of 40 | May lengthen corridor waits |
| Radiology confirms the slot first | 15 of 40 | Ward and porter causes remain |
| Transport adds one porter each morning | 13 of 40 | Ward and radiology causes remain |
| Working group from all three services | All 40 | Examines handoffs together |

Quality improvement principles
This is a classic systems problem. Quality improvement focuses on processes rather than blaming individuals or single departments. A working group or task force can use tools such as a process flowchart of the trip from request to return, a cause-and-effect (fishbone) diagram, and Plan-Do-Study-Act cycles to test changes and measure their effect on waiting time. Including frontline staff from each service builds ownership and makes solutions more likely to last.

The charge nurse's role
The charge nurse has already done the first step well: collecting data instead of relying on opinions. The next step is to share the audit with all three services and propose a joint group, with support from managers who can authorize changes across departments.

Exam takeaway
Key point When causes are spread across several departments and each blames the others, the lasting solution is a cross-department working group, not a fix in one service.

## 임상 시나리오

Fixing Cross-Department DelaysA systems approach to radiology waits
The audit found three causes of similar size: ward requests (12), porters (13), and radiology readiness (15), each in a different service.

Fixing only the largest category still leaves 25 of 40 delays. A working group with members from all three services can examine the handoffs together.

Use tools such as a process flowchart, a fishbone diagram, and Plan-Do-Study-Act cycles to test changes.

CautionDo not blame one service. Single-service fixes can shift the delay elsewhere instead of solving it.

## 핵심 개념

- **Task force** — A temporary working group formed to study and solve a specific problem.
- **Cross-functional team** — A team with members from different departments or services working on a shared problem.
- **Plan-Do-Study-Act cycle** — A quality improvement method of planning a change, testing it, studying results, and acting on them.
- **Fishbone diagram** — A cause-and-effect diagram that groups possible causes of a problem by category.

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