Teklewold Berhanetsehay, Anteneh Dagmawi, Kebede Dawit, Gezahegn Wendmagegn
Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Clinical Governance and Quality Improvement Directorate, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Risk Manag Healthc Policy. 2021 Jan 26;14:273-282. doi: 10.2147/RMHP.S284835. eCollection 2021.
Failure mode and effect analysis is an important tool to identify failures in a system with its possible cause, effect, and set actions to be implemented proactively before the occurrence of problems. This study tries to identify common failure modes with its possible causes and effect to the health service and to plot actions to be implemented to reduce COVID-19 transmission to clients, staff, and subsequent service compromise from asymptomatic COVID-19 patients visiting the adult emergency department of SPHMMC (non-COVID-19 setup).
A multidisciplinary team, representing different divisions of the adult emergency department at St. Paul's Hospital Millennium Medical College (SPHMMC), was chosen. This team was trained on failure mode and effect analysis and basics of COVID-19, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure, and plan changes in practice.
A total of 22 failure modes and 89 associated causes and effects were identified. Many of these failure modes (12 out of 22) were found in all steps of patient flow and were associated with either due to lack of or failure to apply standard and transmission-based precautions. This suggests the presence of common targets for improvement, particularly in enhancing the safety of staff and clients. As a result of this FMEA, 23 general improvement actions were proposed.
FMEA can be used as a useful tool for anticipating potential failures in the process and proposing improvement actions that could help in reducing secondary transmissions during the pandemic.
失效模式与效应分析是一种重要工具，用于识别系统中的故障及其可能的原因、影响，并在问题发生前主动采取相应措施。本研究旨在识别常见的失效模式及其对医疗服务可能的原因和影响，并制定相应措施以减少新冠病毒传播给患者、工作人员，并避免无症状新冠患者前往圣保禄医院千禧医学院成人急诊科（非新冠专用设置）导致后续服务受损。
选取了一个代表圣保罗医院千禧医学院成人急诊科不同科室的多学科团队。该团队接受了失效模式与效应分析以及新冠病毒基础知识的培训，以识别可能的故障原因及其潜在影响，计算每个故障的风险优先数（RPN），并规划实际操作中的改进措施。
共识别出22种失效模式以及89种相关的原因和影响。其中许多失效模式（22种中的12种）在患者就医流程的各个环节均有发现，且与缺乏或未实施标准及基于传播的预防措施有关。这表明存在共同的改进目标，特别是在提高工作人员和患者的安全性方面。基于此次失效模式与效应分析，提出了23项总体改进措施。
失效模式与效应分析可作为一种有用的工具，用于预测过程中的潜在故障，并提出有助于在疫情期间减少二次传播的改进措施。
