Failure mode and effects analysis: a comparison of two common risk prioritisation methods
Failure mode and effects analysis: a comparison of two common risk prioritisation methods
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DOI：
10.1136/bmjqs-2015-004130
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发表时间：
2016-05-01
影响因子：
5.4
通讯作者：
Holl, Jane L.
中科院分区：
文献类型：
--
作者：
McElroy, Lisa M.;Khorzad, Rebeca;Holl, Jane L.
背景失效模式与效应分析（FMEA）是一种风险评估方法，在过去十年中越来越多地用于医疗保健。然而，传统的方法可能需要大量的时间和培训资源。本研究的目的是比较一个简化的评分方法与传统的评分方法，以确定一致的程度，在识别高风险failure.Methods FMEA的手术室（OR）重症监护室（ICU）的交接进行。使用传统的风险优先数（RPN）和基于关键性的方法以及将故障指定为“高”，“中”或“低”风险的简化方法对故障进行评分和排名。一致性程度的确定，首先确定这些故障确定为关键的传统方法（RPN >= 300），然后计算百分比的一致性与这些故障指定的关键的简化方法（高风险）。传统方法得出的关键性指数（CI）范围为18至72，RPN范围为80至504。简化的方法将11例故障评为“低风险”，30例为中等风险，22例为高风险。传统方法产生了24个RPN >= 300的失败，其中22个被简化方法识别为高风险（92%的一致性）。前20%的CI（>= 60），包括12个故障，其中6个被指定为高风险的简化方法（50%协议）。结论这些结果表明，简化的方法，由FMEA确定的评分和排名故障可以是一个有用的工具，为医疗机构有限的FMEA专业知识。然而，简化的方法并没有导致相同程度的歧视，在传统的方法提供的故障排序。
Background Failure mode and effects analysis (FMEA) is a method of risk assessment increasingly used in healthcare over the past decade. The traditional method, however, can require substantial time and training resources. The goal of this study is to compare a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures.Methods An FMEA of the operating room (OR) to intensive care unit (ICU) handoff was conducted. Failures were scored and ranked using both the traditional risk priority number (RPN) and criticality-based method, and a simplified method, which designates failures as 'high', 'medium' or 'low' risk. The degree of congruence was determined by first identifying those failures determined to be critical by the traditional method (RPN >= 300), and then calculating the per cent congruence with those failures designated critical by the simplified methods (high risk).Results In total, 79 process failures among 37 individual steps in the OR to ICU handoff process were identified. The traditional method yielded Criticality Indices (CIs) ranging from 18 to 72 and RPNs ranging from 80 to 504. The simplified method ranked 11 failures as 'low risk', 30 as medium risk and 22 as high risk. The traditional method yielded 24 failures with an RPN >= 300, of which 22 were identified as high risk by the simplified method (92% agreement). The top 20% of CI (>= 60) included 12 failures, of which six were designated as high risk by the simplified method (50% agreement).Conclusions These results suggest that the simplified method of scoring and ranking failures identified by an FMEA can be a useful tool for healthcare organisations with limited access to FMEA expertise. However, the simplified method does not result in the same degree of discrimination in the ranking of failures offered by the traditional method.