From the Health System Management Program, Department of Management, Bar Ilan University, Ramat Gan.
Shalvata Medical Center, Hod Hasharon, Israel.
J Patient Saf. 2023 Oct 1;19(6):362-368. doi: 10.1097/PTS.0000000000001127. Epub 2023 May 10.
Failure mode and effect analysis (FMEA) is a powerful tool for accessing potential failures, but the participants are limited. It has not been used in psychiatric hospitals. Objectives were to implement FMEA in a psychiatric hospital and determine whether the FMEA process can be expanded by including participants who are familiar with the emergency department (ED) admission process and those who are not.
In this prospective, questionnaire-based study, a multidisciplinary team experienced in ED admissions was trained in FMEA and determined potential failures in the process. They developed a questionnaire regarding the failures, which were ranked by 17 ED and 28 non-ED healthcare providers. Risk priority numbers were calculated for each.
By applying FMEA, we found 6 steps of the ED admission process, with 32 potential failures. Risk priority numbers ranged from 91 to 225. The most notable potential failure identified was during a patient's initial telephone call to the ED, before arrival. Emergency department and non-ED workers ranked 94% of the potential failures similarly.
Failure mode and effect analysis can be implemented in psychiatric hospitals and can be a useful tool for anticipating potential failures. The number of participants in an FMEA can be increased to include those who are not directly involved in the process and should involve several specialists from diverse fields. Increasing the number of participants allows more detailed analyses. A checklist detailing the actions to take when processing a patient's initial phone call should be implemented to decrease hazards related to ED admissions.
失效模式与影响分析（FMEA）是评估潜在故障的强大工具，但参与者有限。它尚未在精神病院使用。目的是在精神病院中实施 FMEA，并确定通过包括熟悉急诊部（ED）入院流程的参与者和不熟悉的参与者，是否可以扩展 FMEA 流程。
在这项前瞻性、基于问卷的研究中，一支在 ED 入院方面经验丰富的多学科团队接受了 FMEA 培训，并确定了该流程中的潜在故障。他们制定了一份关于这些故障的问卷，由 17 名 ED 和 28 名非 ED 医疗保健提供者进行排名。为每个故障计算了风险优先数。
通过应用 FMEA，我们发现 ED 入院流程有 6 个步骤，有 32 个潜在故障。风险优先数范围从 91 到 225。识别出的最显著的潜在故障发生在患者最初致电 ED 到达之前。ED 和非 ED 工作人员对 94%的潜在故障的排名相似。
失效模式与影响分析可以在精神病院中实施，并且可以成为预测潜在故障的有用工具。可以增加 FMEA 的参与者数量，包括那些不直接参与该过程的人，并应包括来自不同领域的多名专家。增加参与者的数量可以进行更详细的分析。应实施一份详细说明处理患者初始电话时应采取的措施的检查表，以减少与 ED 入院相关的危险。
