運用醫療照護失效模式與效應分析改善急診轉住院流程－－以某醫學中心為例

Use of Healthcare Failure Mode and Effect Analysis to Improve Emergency Admissions - Experience in a Medical Center

目的：醫界逐步推行的重要品管手法之一為醫療失效模式與效應分析，財團法人醫院評鑑暨醫療品質策進會於新制醫院評鑑條文中建議醫院應建立危機管理機制，運用危機預防處理模式分析以預防危機事件發生。本文以急診轉住院流程改善，利用醫療失效模式與效應分析流程，以提供病人安全就醫環境。方法：研究時間點為2009年1月～2011年1月。研究步驟為（1）決定改善主題；（2）組成團隊；（3）繪製流程圖；（4）進行危害分析；（5）擬定行動方案及結果量測。以跨團隊改善方式進行品質改善活動，共同腦力激盪及標竿學習，共同討論擬出各項改善對策，包括加強溝通機制、床位資訊透明化、人員教育訓練等等。結果：透過流程的分析發現改善前有九項失效模式需加以改善，包括醫護溝通的問題、住院及出院流程延誤、床位控管不佳等。改善後各項模式皆已有有效衡量控制方式或是危害指數低於8分，急診轉住院比率由24.10％提升至30.02％，改善成效顯著。結論：透過團隊合作已有效提升急診病人轉住院效率，未來將按照醫療失效模式與效應分析所發現的失效模式，持續監測急診病人轉住院的安全性。

Objective: Healthcare Failure Mode and Effect Analysis (HFMEA) has become an important method for quality improvement in the healthcare industry. The Taiwan Joint Commission on Hospital Accreditation and Healthcare Quality Improvement (TJCHA) lists crisis management as a required accreditation item, and suggests that hospitals take proactive measures, such as HFMEA, to establish hospital-wide risk management programs. Methods: From January 2009 to January 2011, the project consisted of the following steps: 1) defi ne the HFMEA topics, 2) assemble the team, 3) create a fl ow chart, 4) conduct hazard analyses,5) formulate action plans, and 6) measure outcomes. Using bench mark learning and brainstorming techniques, we organized a multi-disciplinary quality improvement task force. Improvement strategies including communication improvement, occupancy information transparency enforcement, and education were implemented. Results: To ensure patient safety, we used HFMEA-initiated process re-engineering to improve emergency admissions in our hospital. Nine failure modes were identified during the process analyses at the beginning of this project; they included physician and nurse communication problems, hospital admission and discharge process delay, and bed turn-over control. After intervention, hazard scores fell under 8 for all failure modes and the emergency admission rate improved signifi cantly from 24.10% to 30.02%. Conclusions: Through team work, we effectively improved the effi ciency of emergency room admissions. We will continue to monitor the safety of the emergency admission process based on the facts found as a result of this HFMEA study.