探讨医疗失效模式与效应分析在危重症患者院内转运流程中的应用研究

目的　探讨运用医疗失效模式与效应分析（HFMEA）改善和优化危重症患者院内转运流程的效果。方法　选取2017年1—4月江苏省某三甲医院急诊科抢救室和重症监护室（ICU）转运的1 488例危重患者纳入对照组，2017年5—8月其转运的1 632例患者纳入观察组。对照组采取凭经验转运的方法，观察组应用HFMEA方法，找出危重症患者院内转运流程可能存在的失效模式，对失效模式的严重度和发生率评分，计算危害指数（RPN），通过决策树分析，决定优先改善的流程，制定并实施解决方案。结果　观察组不良事件发生率为5.94%（97/1 632），低于对照组的22.58%（336/1 488）（χ2=180.249，P<0.001）。观察组患者满意度为95.96%（1 566/1 632），高于对照组的77.96%（1 160/1 488）（χ2=229.378，P<0.001）；观察组接收/检查科室满意度为94.98%（1 550/1 632），高于对照组的68.95%（1 026/1 488）（χ2=364.806，P<0.001）。结论　通过运用HFMEA优化了危重症患者院内转运流程，降低了转运过程中失效模式的发生风险，保障了危重患者院内转运安全。

Application of Healthcare Failure Mode and Effect Analysis in the Hospital Transfer Process for Critically Ill Patients

Objective　To investigate the effects of healthcare failure mode and effect analysis （HFMEA） on improving and optimizing the intrahospital transfer process for critically ill patients.Methods　A total of 1 488 critical patients who were transferred from emergency room or ICU between January 2017 and April 2017 in the Third Grade ＆ Class a Hospital in Jiangsu were included in the control group，and 1 632 patients who were transferred between May 2017 and August 2017 were included in the observation group.The empirical transfer method was used in the control group，whereas HFMEA was used in the observation group.The potential failure modes were identified，and their severity and incidence were scored to calculate risk priority numbers （RPN）.The decision tree method was used to determine optinal processes，and the associated solutions were developed and implemented.Results　The incidence of adverse events in the observation group was 5.94% （97/1 632），which was lower than the 22.58% （336/1 488） in the control group （χ2=180.249，P<0.001）.The patient satisfaction in the observation group was 95.96% （1 566/1 632），which was higher than the 77.96% （1 160/1 488） in the control group （χ2=229.378，P<0.001）；the satisfaction of the receipt/examination department in the observation group was 94.98%（1 550/1 632），which was higher than the 68.95% （1 026/1 488） in the control group （χ2=364.806，P<0.001）.Conclusion　The use of HFMEA optimizes the intrahospital transfer process for critically ill patients，reduces the risk of failure in the transfer process，and ensures the safety of critically ill patients.