Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care
Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care
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DOI：
10.5811/westjem.2014.4.20489
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发表时间：
2014-07-01
影响因子：
3.1
通讯作者：
Tanabe, Paula
中科院分区：
文献类型：
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作者：
Thornton, Victoria L.;Holl, Jane L.;Tanabe, Paula
简介：镰状细胞病 (SCD) 患者经常因剧烈疼痛而到急诊室 (ED) 寻求治疗。然而，有证据表明，他们经历了不准确的评估、次优的护理和不充分的后续转诊。该项目的目的是 1) 探索在两个 ED 中应用失败模式、影响和关键性分析 (FMECA) 的可行性，检查 SCD 患者的四个护理流程（分诊、镇痛管理、高风险/高用户和转诊），2) 报告每个 ED 中这些护理流程的失败情况。方法：在两家医院对 ED SCD 患者护理进行了 FMECA。一个多学科小组检查了四个过程的每一步。提供者识别每个步骤中的失败，然后描述频率、影响和保障措施，从而进行风险分类。结果：两个机构都存在许多“高风险”失败，包括缺乏对高风险或高用户患者的认识以及缺乏对心理社会转诊的重视。具体到 SCD 镇痛管理，一个机构不一致地使用现有的镇痛政策，而另一个机构则没有此类政策。结论：FMECA 有助于识别 ED SCD 护理的失败并指导质量改进活动。干预措施可以侧重于这些特定领域的改进，旨在改进 ED SCD 护理的提供和组织。改进应符合即将出台的国家心、肺和血液赞助的镰状细胞病患者治疗指南。
Introduction: Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED.Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multi-disciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization.Results: Many "high risk" failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies.Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease.