Using “Healthcare Failure Mode & Effects Analasis” to ReduceIn-hospital Cardiac Arrest

• Main Authors: Shue-Ren Wann, 萬樹人
• Other Authors: Ying-Chun Li
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/3bzpm4

碩士 === 國立中山大學 === 高階經營碩士班 === 104 === 《Research issue》 In-hospital cardiac arrest (IHCA) is an important patient safety issue with a high risk nature in hospitals. Monitoring the incidence of IHCA is a very important indicator of quality improvement. The majority of initially resuscitated adult IHCA patients die during hospitalization, and only 15-20% of them survive to discharge. Once the event occurs, the patient will suffer fatal injuries and the impact on his family and society will be tremendous. How to early detect deteriorating patients, prevent IHCA and subsequently improve the prognosis of patients becomes an important task in various medical institutes. In clinical setting, both early detection of warning signs of IHCA and timely intervention of rapid response teams improve outcome. 《Research design》 In this study, we conducted a Quality Control Circle (QCC) with a multidisciplinary team involving staffs of Department of Medicine, the emergency department (ED), cardiovascular center, intensive care unit (ICU) and nursing. We surveyed nearly one million patient-days of hospitalization in a total of three years and achieved a comprehensive improvement. We used Healthcare Failure Mode and Effects Analysis (HFMEA) approach to identify inefficient steps in the IHCA pathway and to assess the efficacy of strategies designed patient-centered to expedite this process. We finally created eight designs, including "the introduction of the national early warning system (NEWS) as a hospital-wide clinical alarming system", "the use of 3-subsequent crescendo NEWS total score reaching ≧7 points as a warning ", "the continuous flashing light as a reminder in health information system", "the changing color as a reminder in nursing information system", "the real-time kanban showing NEWS in each ward", "the real-time screen saver showing NEWS in each computer", "the monitoring the NEWS day-and-night by a rapid response team composed of ED and ICU doctors", "the establishment of NEWS Line group to facilitate intra-group communication" and educating staffs deeply in their heart " the first thing in the morning is to look at NEWS ", and "the first thing on duty is to look at NEWS". Finally, we are able to achieve our goals. 《Research Results & Contribution》 In this study, we improved both the density and the incidence of IHCA, from 0.38 ‰ to 0.20 ‰, and 2.53 ‰ to 1.32 ‰ respectively. Additionally, we have achieved more benefits via improving the awareness and the identity of an early warning system¬-—NEWS. We decreased the occurrence of medical disputes and increased the ICU turnover rate. We also enhanced the survival-for-48 hours and survival-to-discharge rate of IHCA patients no matter the initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. As a result, we reduced the in-hospital mortality rate & mortality density. It is estimated that we will successfully rescue an average of 47 additional patients from death annually.