模糊失效模式与影响分析联合多元管理在骨科康复治疗设备管理中的临床效能研究

Research on clinical effectiveness of fuzzy failure mode and effects analysis combined with multi-dimensional management in orthopedic rehabilitation equipment management

目的:构建模糊失效模式与影响分析(FMEA)联合多元管理模式用于骨科康复治疗设备的管理中,提升骨科康复治疗设备管理质量。方法:梳理骨科康复治疗设备失效模式和7个失效原因为风险控制对象,采用模糊算法评价风险的严重程度、发生概率、可探测度和优先值,从日常巡查、质量检测、维护维修和应急管理方面制定多元管理对策。选取医院骨科临床在用的65台康复治疗设备,按照管理方法不同将其分为对照组(49台)和观察组(54台),包含对照组中的38台和新增加的16台),对照组采用传统的FMEA优先值管理方式,观察组采用模糊FMEA联合多元管理方法,对比两组设备失效占比、FMEA风险评估值和医疗设备服务质量。结果:观察组设备开机自检异常、治疗运行质量差、故障停机、质检不合格和造成外界伤害的平均失效占比分别为(0.76±0.89)%、(1.72±1.35)%、(1.07±1.22)%、(2.19±0.93)%和(0.13±0.26)%,均低于对照组,其差异有统计学意义(Z=2.455,Z=2.833,Z=2.236,Z=3.637,Z=2.014;P<0.05);观察组设备风险的严重程度、发生概率、可探测度和优先值评分分别为(3.34±1.57)分、(2.56±0.94)分、(3.63±1.20)分和(31.29±20.80)分,均低于对照组,其差异有统计学意义(Z=2.117,Z=2.665,Z=3.149,Z=3.466;P<0.05);随机选取的50例患者、37名相关医护人员和120次设备抽检评价结果显示观察组设备的患者满意度、医护认可度和抽检规范度分别为88%(44/50)、97.30%(36/37)和96.67%(116/120),均高于对照组,其差异有统计学意义(χ^(2)=4.882,χ^(2)=6.198,χ^(2)=8.819;P<0.05)。结论:模糊FMEA联合多元管理模式能够降低骨科康复治疗设备失效比例,控制设备风险严重程度、发生概率和可探测度,提高设备运行安全性和临床服务水平。

Objective:To construct a fuzzy failure mode and effects analysis(FMEA)combined multi-dimensional management mode to improve the management quality of orthopedic rehabilitation treatment equipment.Methods:14 types of failure modes in 5 aspects and 25 common situations in 7 aspects of failure causes of orthopedic rehabilitation equipment were selected as risk control objects.Fuzzy algorithm was used to evaluate the risk severity,probability of occurrence,detectability and priority value,and multi-dimensional management countermeasures were developed from the aspects of daily inspection,quality detection,maintenance and emergency management.65 units of rehabilitation treatment equipment in clinical use in the hospital were selected and divided into control group(49 units)and observation group(54 units,including 38 units in the control group and 16 newly added units)according to different management methods.The control group adopted traditional FMEA priority value management method,and the observation group adopted fuzzy FMEA combined multi-dimensional management method.The equipment failure ratio,FMEA risk assessment value and medical equipment service quality were compared between the two groups.Results:The proportion of failures due to abnormal power-on self-test,poor treatment operation quality,malfunction shutdown,unqualified quality inspection and external damage of the orthopedic rehabilitation treatment equipment in the observation group were(0.76±0.89)%,(1.72±1.35)%,(1.07±1.22)%,(2.19±0.93)%and(0.13±0.26)%,respectively,which was lower than that of control group,the difference was statistically significant(Z=2.455,Z=2.833,Z=2.236,Z=3.637,Z=2.014;P<0.05).The severity,incidence,detectability and priority values of orthopedic rehabilitation equipment risk in the observation group were(3.34±1.57)points,(2.56±0.94)points,(3.63±1.20)points and(31.29±20.80)points,respectively,which were lower than that in the control group,the difference was statistically significant(Z=2.117,Z=2.665,Z=3.149,Z=3.466;P<0.05).The results of 50 randomly selected patients,37 related medical staff and 120 random inspection showed that the patient satisfaction,medical staff recognition and random inspection standardization of the equipment in the observation group were 88%(44/50),97.30%(36/37)and 96.67%(116/120),respectively,which were higher than those in the control group,the difference was statistically significant(χ^(2)=4.882,χ^(2)=6.198,χ^(2)=8.819;P<0.05).Conclusion:Fuzzy FMEA combined with multi-dimensional management mode can reduce the failure rate of orthopedic rehabilitation equipment,control the severity,occurrence probability and detectability of equipment risks,and improve the equipment operation safety and clinical service level.