Taleghani Yasamin Molavi, Rezaei Fatemeh, Sheikhbardsiri Hojat
Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Science, Isfahan, Iran.
Department of Disaster and Emergency Medical Management Center, Kerman University of Medical Science, Kerman, Iran.
World J Emerg Med. 2016;7(2):97-105. doi: 10.5847/wjem.j.1920-8642.2016.02.003.
Ensuring about the patient's safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care.
In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used.
In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.
"Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.
确保患者安全是提高医疗质量的首要关键步骤，而急诊病房是医疗保健治疗中的高风险区域。本研究旨在通过医疗保健中的条件和失效影响分析方法，评估马什哈德一家教学治疗中心——卡姆中心急诊外科选定的风险流程。
在本研究中（定性行动研究与定量横断面研究相结合），根据医疗保健失效模式与效应分析（HFMEA），识别并分析了急诊外科5个高风险手术流程的失效模式及效应。从“临床管理模式中的护理差错（NECM）”对失效模式进行分类，采用“埃因霍温模型”对差错的有效原因进行分类，并运用“发明问题解决理论”确定改进策略。采用描述性统计（总分）的定量数据分析方法以及内容分析和成员意见一致性分析来分析定性数据。
通过“使用评分的投票法”在5个选定流程中，HFMEA识别出23个步骤、61个子流程和217个潜在失效模式。检测到25个（11.5%）作为高风险差错的失效模式，并将其转移到决策树中。失效模式最多和最少的分别位于护理差错类别（54.7%）和知识与技能类别（9.5%）。此外，29.4%的预防措施属于人力资源管理策略类别。
“流程修订与重新设计”“工作的持续监测”“操作程序和政策的制定与修订”“制定人员绩效评估标准”“根据员工需求设计合适的教育内容”“培训患者”“减轻工作量和电力短缺”“改善团队沟通”以及“设备的预防性管理”作为指导方针被提上议程。
