Casualty Department

Patient Totals

New (Tally) Existing (Tally) Total (#) Discharges Tally (#)
Patients
Data Collection Tracker
Key Variables Captured (Tally) Partially Captured (Tally) Not Captured (#) Unknown (#) Comments
Demographics
Vitals
Clinical
Root Cause Tracker
Key Variables Not Collected (Tally) No Equipment Equipment Broken Pt Uncooperative Unclear Other (comment)
Demographics
Age
Gender
Vitals
Heart Rate
Blood Pressure
Temp
Pulse Ox
Clinical
Diagnosis
GCS
Discharge Outcome

ICU

Patient Totals

New (Tally) Existing (Tally) Total (#) Discharges Tally (#)
Patients
Data Collection Tracker
Key Variables Captured (Tally) partially Captured (Tally) Not Captured (#) Unknown (#) Comments
Demographics
Vitals
Clinical
Root Cause Tracker
Key Variables Not Collected (Tally) No Equipment Equipment Broken Pt Uncooperative Unclear Other (comment)
Demographics
Age
Gender
Vitals
Heart Rate
Blood Pressure
Temp
Pulse Ox
Clinical
Diagnosis
GCS
Discharge Outcome

Male Ward

Patient Totals

New (Tally) Existing (Tally) Total (#) Discharges Tally (#)
Patients
Data Collection Tracker
Key Variables Captured (Tally) partially Captured (Tally) Not Captured (#) Unknown (#) Comments
Demographics
Vitals
Clinical
Root Cause Tracker
Key Variables Not Collected (Tally) No Equipment Equipment Broken Pt Uncooperative Unclear Other (comment)
Demographics
Age
Gender
Vitals
Heart Rate
Blood Pressure
Temp
Pulse Ox
Clinical
Diagnosis
GCS
Discharge Outcome

Female Ward

Patient Totals

New (Tally) Existing (Tally) Total (#) Discharges Tally (#)
Patients
Data Collection Tracker
Key Variables Captured (Tally) partially Captured (Tally) Not Captured (#) Unknown (#) Comments
Demographics
Vitals
Clinical
Root Cause Tracker
Key Variables Not Collected (Tally) No Equipment Equipment Broken Pt Uncooperative Unclear Other (comment)
Demographics
Age
Gender
Vitals
Heart Rate
Blood Pressure
Temp
Pulse Ox
Clinical
Diagnosis
GCS
Discharge Outcome

Pediatric Ward

Patient Totals

New (Tally) Existing (Tally) Total (#) Discharges Tally (#)
Patients
Data Collection Tracker
Key Variables Captured (Tally) partially Captured (Tally) Not Captured (#) Unknown (#) Comments
Demographics
Vitals
Clinical
Root Cause Tracker
Key Variables Not Collected (Tally) No Equipment Equipment Broken Pt Uncooperative Unclear Other (comment)
Demographics
Age
Gender
Vitals
Heart Rate
Blood Pressure
Temp
Pulse Ox
Clinical
Diagnosis
GCS
Discharge Outcome

People present for round

Personnel Completed Full Rounds Partially completed Not Present Comment