Risk assessment of the emergency processes: Healthcare failure mode and effect analysis

doi:10.5847/wjem.j.1920-8642.2016.02.003

Abstract

Abstract:

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: "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.

Key words: Emergency, Risk assessment, Healthcare failure mode

Yasamin Molavi Taleghani, Fatemeh Rezaei, Hojat Sheikhbardsiri. Risk assessment of the emergency processes: Healthcare failure mode and effect analysis[J]. World Journal of Emergency Medicine, 2016, 7(2): 97-105.

Figures/Tables 5

Table 1

Table 2

Distribution of failure modes in each area of the error scoring matrix and classification of failure modes based on the model of management association of nursing error for the selected emergency surgery processes

High-risk processes of emergency surgery	Number of sub-processes	Number of failure modes	Number of intervention levels categories				Frequency percentage of failure modes based on association model of "management of nursing error"
High-risk processes of emergency surgery	Number of sub-processes	Number of failure modes	Emergency levels	Urgent levels	Programing levels	Monitoring levels	Care process errors	Communication errors	Administrative process errors	Knowledge and skill errors
Care and patients nursing
Ordered by physician	2	9	0	0	8	1	7	4	3	0
Checking and importing of illegible prescriptions by nurse patient	2	5	0	0	5	0	5	0	2	2
Executing the physician's commands and nursing records	2	16	0	0	16	0	11	4	3	2
Collection and delivery of patients records to the secretory	1	4	0	0	2	2	3	1	1	0
First visit of the patient
Filing in the ward	1	4	0	0	3	1	4	0	1	0
History taken by the intern and examination by the resident	5	19	0	0	18	1	13	8	7	1
Doing the tests and required graphs	1	4	0	0	4	0	4	1	1	1
Checking and implementation of physician's commands	3	9	0	0	7	2	8	4	9	2
Patient radiology
Request for radiology	2	8	0	2	5	1	5	2	0	1
Request a graph with surgical emergency admission	2	6	0	0	6	0	1	2	2	2
Request a graph from the ward to the radiology unit	3	6	0	0	6	0	2	3	2	0
Transfer patients to the radiology unit	1	7	0	5	2	0	8	0	1	0
Doing radiology	1	4	0	0	2	2	4	0	1	0
Get answers and report	2	5	0	0	5	0	5	0	1	1
Laboratory management
Request for the laboratory test	6	19	0	4	14	1	17	7	0	1
Collecting and sending samples	4	16	0	3	13	0	13	2	5	4
Sample analysis	4	15	0	3	12	0	14	0	6	1
Laboratory test result issue	1	4	0	3	1	0	4	0	2	2
Report to the related physician	2	5	0	1	4	0	4	0	0	1
Outpatient admission
Accepting patient in triage	4	15	0	4	11	0	15	6	1	0
Patient transfer to the emergency surgery	2	7	0	0	7	0	7	3	0	0
Central reception and temporary early filing of hospitalization	4	14	0	0	3	11	14	4	0	0
Patient admission in the ED surgery	3	7	0	0	3	4	6	1	1	0
Total score	61	217	0	25	166	26	181	54	53	21

Table 2

Table 3

Table 4

The worksheet of failure modes techniques and HFMEA for some high-risk failure modes of the selected emergency surgery processes

Hazard analysis									Action and outcome measures
Failure mode	Potential causes	Scoring			Decision tree analysis			Proceed?	Action type	Actions or rate for stopping
Failure mode	Potential causes	Severity	Occu-rrence	Hazard score	Weakness point	Existing control measures	Detecta-bility	Proceed?	Action type	Actions or rate for stopping
Recording the incorrect information in triage sheet	→	3	3	9	→	No	No	Yes
	1) Giving false information from the patient or not having knowledgeable person	3	3	9	→	No	No	Yes	C	1) Assessing the patient's ability to communicate effectively with healthcare providing; 2) Detailed examination of the patient and not limited to what patient said
	2) Lack of a correct communication of physician with patient	3	2	6	→	No	No	Yes	C	1) Assessing the patient's ability to communicate effectively with healthcare providing; 2) Developing the criteria of performance evaluation and monitoring clinical process; 3)Training course of effective communication and respect to the rights of service recipients
	3) Lack of confidence of the patient and patient's caregiver to the nurse	3	3	9	→	No	Yes	No	C	1) Assessing the ability of patient to communicate effectively with healthcare provider; 2) Catches the patient's desire for giving information; 3) Implementation of the ethics nursing codes in the hospital for better interaction with the patient
Error in patient transfer to the emergency surgery (incorrect refer of patient)	→	3	3	9	→	No	No	Yes
	1) Incorrect decision by physician	3	2	6	→	No	No	Yes	C	1) Correct communication with patient; 2) Detailed examination and complete knowledge of the patient's clinical condition; 3) Correct history taking from the patient; 4) Taking into account the advice of other clinicians by the service provider if necessary
	2) Lack of a good protocol to determine the correct situation of patient	3	3	9	→	No	Yes	No	C	1) Assessing the patient's ability to communicate effectively with healthcare provider; 2) Detailed examination of the patient and not limited to what patient said
Delay to refer patient to the radiology	→	3	3	9	→	No	No	Yes
	1) Absence of nurse aid or the intern	3	3	9	→	No	Yes	No	C	1) Coordination in medical team; 2) Sharing information in medical team; 3) Responsibility about patient safety
	2) Lack of cooperation of patient and being unstable of the patient	3	4	12	→	No	No	Yes	C	1) Cooperation for receiving information and consequences of each method; 2) Awareness of patient about the need to do radiology; 3) Monitoring the work process; 4) To pass information sharing between the medical team
	3) Lack of cooperation, coordination and team problems between radiology and emergency surgery	3	3	9	→	No	No	Yes	C	1) Sharing the information between medical team; 2) Training courses of team work; 3) Continuous monitoring of doing process; 4) Coordinated acting of medical team
	4) Overcrowding in radiology and or emergency surgery	3	3	9	→	No	Yes	No	C	1) Supply of additional power; 2) Fitting the work volume with number of human resources; 3) Coordination of medical team and establishment of stress management; 4) Determination of standard range and keeping client data in the standard range; 5) Coordination between radiology and surgery wards
Unnecessary graph for patient is requested by the physician	→	3	3	9	→	No	No	Yes
	1) Lack of correct communication of physician with the patient	3	2	6	→	No	No	Yes	C	1) Assessing the patient's ability to communicate effectively with healthcare provider; 2) Developing criteria of performance evaluation and monitoring the clinical process; 3) Training course of effective communication and respect to the rights of service recipients
	2) Lack of knowledge and enough skill by physician	3	2	6	→	No	No	Yes	C	1) Encourage physicians to ask about the ambiguity (taking into account the comments of other experts); 2) Periodic training for clinical staff
Delay in the beginning of the test on the intended sample in laboratory	→	3	4	12	→	No	No	Yes
	1) Overcrowding of the laboratory	3	4	12	→	No	Yes	No	C	1) Reducing the workload and arranging the tables of work shifts and avoid of row shifts; 2) Supply of additional power; 3) Fit the work volume with the number of human resources; 4) Coordination of medical team and establishment of stress management
	2) Lack of awareness of the importance of the subject	3	3	9	→	No	No	Yes	C	1) Performing a justification course at the beginning; 2) Determination a leader or supervisor for the team; 3) Sharing information with medical team; 4) Continuous monitoring of healthcare providing
	3) Lack of monitoring of a technical responsible on the process of doing work	3	3	9	→	No	No	Yes	C	1) Periodic monitoring and evaluation of laboratory; 2) Checking the competence of the team leader and responsible person; 3) Continuous monitoring of doing processes
Failure (error) in entering test answer in the system through laboratory	→	3	3	9	→	No	No	Yes	C
	1) High work volume and staff fatigue	3	4	12	→	No	No	Yes	C	1) Programing and management of actions during the shift; 2) Work division; 3) Setting shift tables and lack of giving ling shifts
	2) Lack of enough experience	3	2	6	→	No	No	Yes	C	1) Evaluation and control of activity and checking the final test answers by technical manager; 2) Developing the careers of introduction of new entrants personnel to the ward's criteria

Table 4

Table 5

Classification of strategies and preventive measures for causes of high-risk error modes (risk score ≥8)

Strategy classification	Improvement strategy by means of the TRIZ method	Patient radiology	Laboratory manage-ment	Outpatient admission	Total
Human resources management	Determination a supervisor for treatment team, evaluation the competency of team leader, conducting periodical assessment and offering feedback to the personnel, Inform treatment team by necessary information, defining the responsibilities and announcing them, reducing the work load and correcting the lack of work forces, continuous supervision and controlling the performance procedures and adjusting the workload with staff.	17	44	7	68
Installation of electronic prescribing system	Implementation procedure on drug combination.	0	1	0	1
Making people accountable to patient's safety	Readable information in patients clinical documents, all reports must have stamp, signature, date and time, culturally appropriate environment for patient safety and deployment an incident reporting system, encouraging the staff to ask question in case of obscurity and resolving the issue of lack of man power, detachment and pursuing the test results in form of root analysis of the events and reporting the critical results.	3	7	2	12
Medical equipment management and process standardization	Regular calibration of medical equipment, emergency service of medical equipment and devices, checklists for maintenance of the tools and facility management, purchasing of protective equipment, creating a qualitative committee and monthly views of the equipment of radiology unit.	6	8	3	17
Improvement of patient identification process	Applying key identifiers in patient identification, improvement of the patient's recognition processes and revising the guidelines for the correct recognition of the patients.	0	6	0	6
Making clear and transparent policies and procedures	The re-engineering of the process, preparing and organizing the executive guidelines and protocols, preparing new forms with special parts, facilitating the processes and removing the unnecessary steps, designing a special check-list for evaluation of the patient's transition between emergency and radiology units, revision policies, simplifying the process and eliminating unnecessary steps and audits process.	5	9	6	20
Making sure about availability of suitable technology for quality improvement	Fundamental improving of the software for entering the physician's commands for tests.	0	3	1	4
Continuous training and briefing care providers at the beginning of employment	Re-training courses and preparing proper training content according to the needs of the personnel, the scientific training for prescription writing and continuous medical training for the physicians, training of recommendation and instructions, continuing the re-training programs for physicians, training of recommendation and instructions.	7	16	3	26
Participating patients in treatment process	His/her accompanying person and teaching all the regulations of the sector and offering the sufficient data and patient's training, patient's contribution by making effective relationship with them, development of educational patients.	5	1	7	13
Implementing and monitoring suitable changes in clinical processes based on analysis of reliable data	Continuous supervision, defining the periodical performance assessment criteria and providing feedback to the personnel, introducing a reference laboratory and performing some of the important tests randomly in various periods as binary tests by the hospital laboratory and the reference lab, monitoring on following up standards.	7	13	2	22
Promotion of communication amongst treatment team members	Don't use of abbreviations, accurate documentation of all oral (telephone) orders, complete registration of the data, obeying the oral commands only in urgent cases.	0	2	3	5
Team work	Coordination of treatment team, holding teamwork training courses, improvement of the inter-sectorial relations and the supervision of the person responsible for the shift on the work in sectors, improving the team relations.	13	22	2	37
Total		63	132	36	231

Table 5

References 43

1	Kaafarani HM, Itani KM, Rosen AK, Zhao S, Hartmann CW, Gaba DM. How does patient safety culture in the operating room and post-anesthesia care unit compare to the rest of the hospital? Am J Surg 2009; 198:70-75.
2	Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of safety climate and safety performance in hospitals. Health Serv Res 2009; 44(2p1):399-421.
3	Burström L, eds. Patient Safety in the Emergency Department: Culture, Waiting, and Outcomes of Efficiency and Quality. 2014.
4	Dehnavieh R, Ebrahimipour H, Molavi-Taleghani Y, Vafaee-Najar A, Hekmat SN, Esmailzdeh H. Proactive Risk Assessment of Blood Transfusion Process, in Pediatric Emergency, Using the Health Care Failure Mode and Effects Analysis (HFMEA). Glob J Health Sci 2014; 7:322. pmid: 25560332
5	Wachter RM. Undestanding patient safety. Library of Congress Cataloging-in-Publication Data; newyourk: T.M.-H.c. medical; 2012.
6	Pham JC, Story JL, Hicks RW, Shore AD, Morlock LL, Cheung DS, et al. National Study on the Frequency, Types, Causes, and Consequences of Voluntarily Reported Emergency Department Medication Errors. Emerg Med 2011; 40:485-492.
7	Watters DA, Truskett PG. Reducing errors in emergency surgery. ANZ J Surg 2013; 83:434-437.
8	Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf 2012; 21:737-745.
9	Ebrahimipour H, Vafaee-Najar A, Hosseini SH, Vejdani M, Heydarabadi AB, Barkati H. Proactive risk assessment of the laboratory management process in Ghaem Hospital, Mashhad (2013). Journal of Paramedical Sciences 2015; 6:85-95.
10	Nagpal K, Vats A, Ahmed K, Smith AB, Sevdalis N, Jonannsson H, et al. A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg 2010; 145:582-588.
11	DeRosier J, Stalhandske E, Bagian JP, Nudell T. Using health care failure mode and effect analysis™: the VA National Center for Patient Safety's prospective risk analysis system. Joint Commission Journal on Quality and Patient Safety 2002; 28:248-267.
12	Cheng CH, Chou CJ, Wang PC, Lin HY, Kao CL, Su CT. Applying HFMEA to prevent chemotherapy errors. J Med Syst 2012; 36:1543-1551.
13	Ibrahimipour H, Vafaee-Najar A, Molavi Y, Vejdani M, Kashfi SH, Babaei Heydarabadi A. Health Care Failure Mode and Effect Analysis: a useful proactive risk analysis of nutrition and food distribution in Mashhad Qaem hospital's women's surgery ward in 2013. Nutrition and Food Sciences Research 2014; 1:19-26.
14	van Tilburg CM, Leistikow IP, Rademaker CM, Bierings MB, van Dijk AT. Health Care Failure Mode and Effect Analysis: a useful proactive risk analysis in a pediatric oncology ward. Qual Saf Health Care 2006; 15:58-63.
15	khani-Jazani R, Molavi-Taleghani Y, Seyedin H, Vafaee-Najar A, Ebrahimipour H, Pourtaleb A. Risk Assessment of Drug Management Process in Women Surgery Department of Qaem Educational Hospital (QEH) Using HFMEA Method (2013). Iran J Pharm Res 2015; 14:495-504.
16	Eadie A. Medical error reporting should it be mandatory in Scotland? J Forensic Leg Med 2012; 19:437-441. pmid: 22920772
17	Wente SJ. Nonpharmacologic pediatric pain management in emergency departments: a systematic review of the literature. J Emerg Nursing 2013; 39:140-150.
18	Göransson KE, De Waern M, Lindmarker P. Patients' pathway to emergency care: is the emergency department their first choice of care? Eur J Emerg Med 2013; 20:45-50.
19	Ebrahimipour H, Najar AV, Taleghani YM. Assessing risks of selected processes in otolaryngology surgery department quaem hospital. Health Information Management 2014; 11:621.
20	Hung SH, Wang PC, Lin HC, Chen HY, Su CT. Integration of Value Stream Map and Healthcare Failure Mode and Effect Analysis into Six Sigma Methodology to Improve Process of Surgical Specimen Handling. J Healthc Eng 2015; 6:377-398. doi: 10.1260/2040-2295.6.3.377 pmid: 26753440
21	ATTAR JNF, Tofighi S, Hafezimoghadam P, Maleki M, Goharinezhad S. Risk assessment of processes of Rasoule Akram emergency department by the failure mode and effects analysis (FMEA) methodology. Hakim Res 2010; 3:15-176.
22	Anderson O, Brodie A, Vincent CA, Hanna GB. A systematic proactive risk assessment of hazards in surgical wards: a quantitative study. Ann Surg 2012; 255:1086-1092. pmid: 22504280
23	Tran D, Johnson M. Classifying nursing errors in clinical management within an Australian hospital. Int Nurs Rev 2010; 57:454-462. pmid: 21050197
24	Bonfant G, Belfanti P, Paternoster G, Gabrielli D, Gaiter AM, Manes M, et al. Clinical risk analysis with failure mode and effect analysis (FMEA) model in a dialysis unit. J Nephrol 2010; 23:111. pmid: 20091494
25	Snijders C, van der Schaaf TW, Klip H, van Lingen RA, Fetter WP, Molendijk A, et al. Feasibility and reliability of PRISMA-medical for specialty-based incident analysis. Qual Saf Health Care 2009; 18:486-491.
26	Weinstein RA, Linkin DR, Sausman C, Santos L, Lyons C, Fox C, et al. Applicability of healthcare failure mode and effects analysis to healthcare epidemiology: evaluation of the sterilization and use of surgical instruments. Clin Infect Dis 2005; 41:1014-1019.
27	Livotov P. TRIZ and innovation management innovative product development and theory of inventive problem solving. INNOVATOR TriS Europe, 2008 (Cited by 3). Available from:URL://triz.it/triz_papers/2008%20TRIZ%20and%20Innovation%20Management.pdf (accessed 11 April 2012).
28	Nasiripour A, Raeissi P, Tabibi S. Development and compilation of strategies and preventive measures for medical errors in public hospitals in Tehran. Journal of Health Administration 2011; 14:21-32.
29	Dominici L, Nepomnayshy D, Brown T, O'Brien P, Alden D, Brams D. P113: Implementation of HFMEA in a bariatric surgery program improves the quality and culture of care. Surgery for Obesity and Related Diseases 2006; 2:346-347.
30	Steele C, Rubin G, Fraser S. Error classification in community optometric practice-a pilot project. Ophthalmic Physiol Opt 2006; 26:106-110. pmid: 16390489
31	Rubin G, George A, Chinn D, Richardson C. Errors in general practice: development of an error classification and pilot study of a method for detecting errors. Qual Saf Health Care 2003; 12:443-447.
32	Spath PL. Using failure mode and effects analysis to improve patient safety. AORN J 2003; 78:15-37.
33	Rezaei F, Yarmohammadian MH, Ferdosi M, Haghshenas A. Developing an integrated clinical risk management model for Hospitals. International Journal of Health System and Disaster Management 2013; 1:221.
34	Smits M, Janssen J, De Vet R, Zwaan L, Timmermans D, Groenewegen P, et al. Analysis of unintended events in hospitals: inter-rater reliability of constructing causal trees and classifying root causes. Int J Qual Health Care 2009; 21:292-300.
35	Smits M, Zegers M, Groenewegen P, Timmermans D, Zwaan L, Van der Wal G, et al. Exploring the causes of adverse events in hospitals and potential prevention strategies. Qual Saf Health Care 2010; 19:1-7.
36	Nasiri M, Heidari M, Shahbazi S, Ansari E. Correlation of human resource strategies based on Allen Ylsy Model with organizational performance staff in Aiat Allah Kashani Hospital. Journal of Health Promotion Management 2013; 2:36-44.
37	Wong J, Beglaryan H, Association OH, eds. Strategies for hospitals to improve patient safety: a review of the research: Change Foundation; 2004.
38	Singh R, Servoss T, Kalsman M, Fox C, Singh G. Estimating impacts on safety caused by the introduction of electronic medical records in primary care. Inform Prim Care 2004; 12:235-241. doi: 10.14236/jhi.v12i4.131 pmid: 15808025
39	Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin 2005; 21:21-30. doi: 10.1016/j.ccc.2004.07.005 pmid: 15579350
40	Latino RJ. Optimizing FMEA and RCA efforts in health care. J Healthc Risk Manag 2004; 24:21-28.
41	Latino RJ, Flood A. Optimizing FMEA and RCA efforts in health care. J Healthc Risk Manag 2004; 24:21-28. pmid: 20196009
42	Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin 2005; 21:21-30. doi: 10.1016/j.ccc.2004.07.005 pmid: 15579350
43	Day S, Dalto J, Fox J, Turpin M. Failure mode and effects analysis as a performance improvement tool in trauma. J Trauma Nurs 2006; 13:111-117. pmid: 17052091

Intervention level	Probability	Catastrophic (4)	Important (3)	Intermediate (2)	Minor (1)
Emergency	Usual (4)	16	12	8	4
Urgent	Sometimes (3)	12	9	6	3
Programming	Unusual (2)	8	6	4	2
Monitoring	Rare (1)	4	3	2	1

Error cause	Care and patients nursing	First visit of the patient	Laboratory management	Outpatient admission	Patient radiology	Total
Technical
External	0	0	0	0	0	0
Design	0	0	0	0	1	1
Structure	0	0	2	2	1	5
Material	0	0	3	0	1	4
Organizational
External	0	0	6	1	4	11
Transfer of knowledge	0	0	2	2	2	6
Protocols	0	0	1	1	2	4
Priorities management	0	0	1	0	1	2
Culture	0	0	3	0	0	3
Human factors
External	0	0	6	0	1	7
Knowledge based	0	0	3	0	2	5
Competence	0	0	1	0	0	1
Cooperation	0	0	3	0	3	6
Evaluation	0	0	0	1	0	1
Action	0	0	1	0	0	1
Monitoring	0	0	4	0	0	4
Slips	0	0	3	1	2	6
Falling	0	0	0	0	0	0
Other factors
Related to patients	0	0	0	3	2	5
Unclassified factors	0	0	1	1	0	2
Total	0	0	40	12	22	74

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