失效模式与效应分析在危重患者院内转运风险管理中的应用

Application of Failure Mode and Effect Analysis in Risk Management of Intrahospital Transfer of Critically Ill Patients

目的探讨医疗失效模式和效应分析(HFMEA)在重症监护室患者院内转运风险管理中的应用.方法对照组(n=826)采用常规转运,观察组(n=912)应用HFMEA方法,通过系统分析转运流程,找出转运中的失效模式,计算风险指数(RPN)值和决策树法,分析潜在失效原因,制定、实施改进方案.结果观察组不良事件发生率为4.71%(43/912),低于对照组的18.40%(152/826)(χ^(2)=81.516,p<0.001).观察组危重患者完成CT/MRI检查、转入对方科室/介入室转运耗时分别为25.64±3.91和20.76±2.78分,均低于对照组的30.94±3.77分(t=23.871,p=0.000)和23.84±3.29分(t=11.563,p=0.000).结论将HFMEA应用于危重患者院内转运中,可以减少不良事件的发生,缩短转运时间,最终保证患者安全转运.

Objective To explore the application of healthcare failure mode and effect analysis(HFMEA)in the risk management of intrahospital transfer of patients in intensive care unit.Methods The control group(n=826)used routine transportation,and the observation group(n=912)used the HFMEA method to systematically analyze the transportation process to find out the failure mode during transportation.The risk priority number(RPN)value was calculated,and the decision tree method was used to analyze the potential failure causes,in order to formulate and implement improvement plans.Results The incidence of adverse events in the observation group was 4.71%(43/912),which was lower than 18.40%(152/826)in the control group(χ^(2)=81.516,p<0.001).The time-consuming of critically ill patients in the observation group to complete CT/MRI examination and transfer to the other department/interventional room were 25.64±3.91 and 20.76±2.78 minutes,respectively,which were lower than the control groups 30.94±3.77 minutes(t=23.871,p=0.000),and 23.84±3.29 minutes(t=11.563,p=0.000).Conclusion The application of HFMEA to intrahospital transfer of critically ill patients can reduce the occurrence of adverse events,shorten the transfer time,and ultimately ensure the safe transfer of patients.