急診零院內感染──運用醫療失效模式與效益分析提升急診疑似COVID-19病人就診流程之安全性

Zero Nosocomial Infections in the Emergency Department - Applying Healthcare Failure Mode and Effect Analysis to Improve the Safety of Emergency Department Care Procedures for Patients Suspected of Having COVID-19

新型冠狀病毒疾病於全球肆虐，急診是醫院防疫第一道防線，全面進行疑似COVID-19病人就診流程改善方案，將能保障同仁職場安全及病人就醫安全。方法運用醫療失效模式與效益分析及結合問題解決型，界定出6項主流程與列出高風險失效原因41項，並採問卷及查核找出17項問題，歸納為教育、流程、政策、環境設備四大方針，實務策略以在職教育、人力分區、物資管理資訊化、流程簡化與標準化、優化設備為方向共擬定26項對策。改善後危害指數總分由339分降至103分，改善率達70％，壓力指數調查由3.06分降至2.81分，防疫流程滿意度提升至90%，此專案提升急診疑似COVID-19病人就診流程的安全性，減少同仁被感染的風險，增加其防疫流程滿意度及降低心理壓力，提升病人醫療照護品質並保護其他病人無感染之疑慮，建構安全醫療環境。

COVID-19 has ravaged the globe, and emergency departments are hospitals’first line of defense. A plan to comprehensively improve care procedures for patients suspected of having COVID-19 will ensure the safety of both employees in the workplace and of patients seeking medical advice. Our methodology used medical failure mode and benefit analysis, in conjunction with problem-solving, to identify six primary procedures and list 41 causes of high-risk failure. In addition, 17 questions were identified through questionnaires and inspection, then distilled into four guiding principles: Education, procedures, policies, and environment/facilities. 26 practical strategies were developed in the areas of in-service education, work zoning, informatization of materials management, process simplification and standardization, and equipment optimization. The total hazard index (HI) score decreased from 339 to 103, and the rate of improvement reached 70%. The survey reveals that the stress index decreased from 3.06 to 2.81, while satisfaction with anti-pandemic processes rose to 90%. This project improved the safety of medical care procedures for patients suspected of having COVID-19; reduced risks of infection among employees; increased satisfaction with anti-pandemic processes; and decreased psychological stress. Additionally, the quality of medical care for patients was improved, while other patients were protected from infection concerns. This helped to build a secure medical environment.