運用醫療失效模式與效益分析改善大量傷患緊急應變作業流程

Using Healthcare Failure Mode and Effects Analysis Improve Emergency Response Protocol for Mass Casualty Incident

大量傷患事件無可避免，醫院是災難因應的首站，拯救生命是它的使命，而緊急應變是成功的關鍵。本專案於2018年6月-2019年3月運用醫療失效模式與效益分析(HFMEA)找出危險因子，依潛在失效原因進行危害指數計算，決策樹分析並擬定行動方案，包括變更支援人力報到分流及簽到方式、採用海報展架及個人標牌、跨單位在職教育、擬真演習及資訊建置等一系列改善，改善後危害指數總分由120分下降至44分，改善率達63%，不僅提升大量傷患緊急應變作業流程流暢性，運用直覺的目視化策略，更有效達到縮短時間及提高即戰力之效率。藉此專案希望提醒他院再審視相關應變措施及平時不間斷的演練及準備，使能早期辨識大量傷患事件，強化醫療應變，減少災害之衝擊與危害，建構安全醫療環境，提升醫療品質。

Mass casualty incidents are inevitable. A hospital adhering to its mission of saving lives is the initial station for emergency responses, while emergency response is the key to success. This project applied the Healthcare Failure Mode and Effect Analysis (HFMEA) from June 2018 to March 2019 to find the risk factors. Based on the causes of potential failure, the hazard score was computed, the decision tree was analyzed, and action plans were formulated. They included changing backup manpower reporting, alternation, and sign-up methods, adopting poster stands, personal signages, cross-departmental in-service education, simulation exercises, information setups, and a series of other improvements. After improvements were made, the hazard index decreased from a total score of 120 to 44, accounting for a 63% improvement. In addition to enhancing the smooth implementation of the mass casualty emergency response protocol, the intuitive visualization strategies more effectively shortened time and increased emergency initiative and response, with efficiency. Through this project, we hope to remind other institutions to re-examine the related response measures and engage in routine drills and preparation without interruption so as to identify mass casualty incidents ahead of time, strengthen medical responses, and reduce disaster impacts and harms, thereby constructing safe medical environments and improving healthcare quality.