The Application Of Failure Mode And Effect Analysis To Reduce Perioperative Medical Risk

Objective:To build a perioperative medical risk management system based on failure mode and effect analysis(FMEA)to reduce the potential perioperative medical risk and ensure the safety of patients' operation.At the same time,to test whether FMEA method is applicable to perioperative risk management in domestic hospitals,and to provide policy recommendations for the relevant administrative departments in perioperative medical risk management.Method:By means of literature review,expert consultation and questionnaire survey,the key points of potential perioperative medical risks were preliminarily drawn up.In March 2018,a questionnaire survey was conducted to understand the perception of potential perioperative medical risks among surgeons in a third-class A general hospital in Nanchang City,Jiangxi Province.The FMEA method was used to find out the potential high-risk failure mode during perioperative period.Brainstorming method and fish bone diagram were used to analyze the failure causes,and intervention measures were formulated for the failure reasons.24 454 surgical patients before intervention from May to August 2018 were taken as control group,and 23 705 surgical patients after intervention from September to December 2018 were taken as intervention group.The mortality,number of unplanned reoperations,average hospitalization days,average medical expenses and risk priority index before and after intervention were compared between the two groups,and the application effect of FMEA was evaluated.Result:1.Through literature review,expert consultation and investigation of potential perioperative medical risk behavior of surgeons,33 potential failure modes in perioperative medical process were listed.By using FMEA method,16 high-risk failure modes in perioperative period requiring priority intervention were identified,i.e.inaccurate or relaxed surgical indications,inadequate preoperative discussion of operative schemes,inadequate preoperative conversation of the chief knife physician,unreasonable operation timing for elderly patients and children,inadequate surgical infection prevention measures and tripartite verification.Serious foreign body remnants,intraoperative blood pressure drop,vascular injury and other emergencies can not be effectively dealt with,the operation is not skilled,the operation exceeds the normal operation time,intraoperative vital signs monitoring is inappropriate,post-operative reassessment is not in place or not assessed,anesthesia awakening exceeds the normal time,serious complications after the operation are not handled properly,operation room and Ward connection problems,holidays and nights The emergency management of patients after operation in special period is not timely,and the post-operative visits are insufficient.2.The failure reasons of high-risk failure modes are analyzed,and corresponding improvement measures are formulated for 23 failure reasons.Compared with the pre-intervention and post-intervention risk priority index(RPN),except for the invariable score before and after the intervention of "insufficient surgical experience and inadequate basic skills",the other RPN scores decreased significantly after the intervention,and the total RPN score decreased from 3618 to 2118,with an average decrease of 41.5%.3.There were 23 705 patients in the intervention group and 24 454 patients in the control group.Four months after the intervention,59 patients died in the intervention group,with a mortality rate of 2.19.93 patients died in the control group,with a mortality rate of 3.8.Statistical analysis showed that there was a significant difference in postoperative mortality between the two groups before and after FMEA(c2=6.607,P < 0.05).4.Four months after the intervention,33 patients in the intervention group had unplanned second operation,the unplanned second operation rate was 1.39 and 45 patients in the control group had unplanned second operation,the unplanned second operation rate was 1.84.Statistical analysis showed that there was no significant difference in the rate of unplanned second operation between the two groups before and after FMEA(c2=1.495,P>0.05).5.The average medical expenses of the intervention group and the control group were 25072.34 yuan and 27378.12 yuan respectively,and the average hospitalization days were 8.56 days and 8.64 days,respectively.The average medical cost of the intervention group was 2305.78 yuan lower than that of the control group,and the average hospitalization days of the intervention group were 0.08 days less than that of the control group.Conclusion:The application of FMEA method can foresee the failure links in perioperative work,determine the key improvement objectives,analyze the causes of failure modes,and effectively reduce the incidence of adverse medical events in perioperative period,and ensure the safety of patients' operation.At the same time,using FMEA method to build perioperative medical risk management system is effective and feasible.It can reduce the possibility of errors and improve safety,and promote the continuous improvement of medical quality.It is worth further promotion.