運用HFMEA改善檢驗危急值通報回覆率

Using Healthcare Failure Mode and Effect Analysis to Improve the Reply Rate of Medical Examination Critical Value Notification

醫療品質及病人安全十項工作目標要求檢驗、檢查、病理報告之危急值有及時通知與處理。個案醫院2009年增設簡訊平台進行危急值通報作業，2011年6月醫療資訊系統具有危急值通報醫師回覆簽收功能。2011年10月至2012年6月危急值通報醫師回覆率平均43%。嘗試使用醫療照護失效模式與效應分析（Health Failure Mode and Effect Analysis, HFMEA）手法，找出危急值（Critical values）醫師回覆率之失效模式、影響效應、嚴重度和發生機率，再以決策樹判斷，導入失效模式與效應分析後，進行根本原因分析再擬定對策改善。經由失效模式分析探討，造成人員失效的系統原因共有11點，經小組成員分析探討，並參考同儕醫院危急值通報及回覆作業流程，擬定對策實施方案。2013年8月改善後系統啟動至12月，24小時醫師回覆率已達98.6%，運用HFMEA模式分析，確實提升醫療照護品質。

In the ten working items of medical quality and patient safety, the critical values appearing in the report of pathogenic examination shall be reported and treated. In this case hospital, we developed a text-mediating platform for reporting critical values in 2009, and amplified to contain confirming function when physician receives the report mentioning critical values in the medical information system on June 2011. After this improvement, the average reply rate from physician when receiving critical value report was 43% between October 2011 and June 2012. We tried to use health failure mode and effect analysis (HFMEA) to find out the failure mode, effects, severity and occurring possibility in the physician reply system. Then, decision tree was used to make judgement and following with failure mode and effect analysis. The improvement plan was made after going through this procedure to find out the basic problem of failure replying. The result indicated 11 points of missing causing the failure. After discussion between every related faculty and referring to other hospital, an improvement procedure was made. The improved procedure was launched since August 2013, the successful reply rate within 24 h reached 98.6% after 3 months of operation. This study confirms that using HFMEA will positively improve the medical care quality.