運用醫療失效模式與效應分析提升門診無痛內視鏡檢查流程順暢及麻醉安全

Using Healthcare Failure Mode and Effect Analysis to Increase the Fluency of Gastrointestinal Endoscopy Scheduling and the Safety of Anesthesia

目的：在麻醉下施行胃鏡及大腸內視鏡需經醫師詳細說明、檢查前基本檢驗檢查與腸道排空等準備事項，若準備事項不完備將阻礙檢查及麻醉順利進行，更甚者檢查被臨時取消。方法：運用HFMEA手法，進行狀況分析、繪製流程圖、危害分析、決策樹分析等前瞻性分析，並及擬定改善對策成效評估。結果：經介入1.建置排程提醒機制、2.提高檢驗報告產出時效、3.修訂麻醉評估檢驗項目、4.整合醫囑開單系統、5.建立麻醉風險評估一致性標準、6.修訂麻醉評估判定流程等改善方案後，除危害指數總分下降外，且檢查前所需的基本檢驗檢查達成率為100％，檢查被臨時取消率為0％。結論：運用HFMEA品管方法可有效率地分析及協助解決複雜的醫療流程，提升排程的流暢度及麻醉品質。

Objectives: Performing gastroscopy and colonoscopy under anesthesia requires detailed explanations from the gastroenterologist and anesthesiologist, basic check-ups, scheduling of check-up dates, and pre-checkup bowel preparation. If these preparations are not completed, the scheduled endoscopy may be cancelled. Methods: Healthcare Failure Mode and Effect Analysis (HFMEA) was utilized to produce procedure flow charts, perform hazard and decision tree analyses, and improve decision making. Thus, work efficiency can be evaluated and improvement strategies can be devised. Results: After introducing an improvement plan (using a new flowchart guide for the OPD procedure, which lists various medical service spots for patients, shortening the production time required for preliminary laboratory reports, refining and unifying anesthetic risk evaluation standards, re-arranging the computer display of the ordering system, and setting up the medical macro-order system), last minute cancellations decreased to zero and the rate of pre-checkup preparations increased to 100%. Conclusions: Using HFMEA ensures more efficient analysis and helps resolve medical procedure complications and difficulties. HFMEA also increases the quality of anesthesia and efficiency of scheduling.