改良型FMEA在颅脑外伤患者诊疗流程风险管理中的应用效果分析研究  

Application of modifed FMEA in the risk management during diagnosis and treatment of patients with craniocerebral trauma

作　　者：戴春雷[1] 季建峰[1] 李峰[1] 沈君华[1] 朱保峰[1] 汪志峰[1] Dai Chunlei;Ji Jianfeng;Li Feng;Shen Junhua;Zhu Baofeng;Wang Zhifeng(The First People's Hospital of Nantong City,Nantong 226004,Jiangsu Province,China)

机构地区：[1]南通市第一人民医院,江苏南通市226004

出　　处：《中国医疗管理科学》2023年第5期112-118,共7页Chinese Journal Of Medical Management Sciences

基　　金：江苏省医院协会医院管理专项研究课题(JSYGY-1-2021-JZ22)。

摘　　要：目的研究改良型失效模式与效应分析法(FMEA)在颅脑外伤患者诊疗流程风险管理中的适用性,为创伤中心的规范化建设提供参考。方法将根因分析法融入失效模式与效应分析法中形成改良型FMEA,以“颅脑外伤患者的诊疗流程”为研究对象,计算其失效模式的风险优先指数,选取分值位列前3名的失效模式作为关键点进行根因分析,并采取相应的预防控制措施,在运行6个月后进行效果评价。结果经干预,这3项高风险失效模式的风险优先指数分值大幅下降;颅脑外伤患者的24小时内死亡率、7天内死亡率都明显下降;颅脑外伤患者的好转率明显升高。结论干预发挥了作用,降低了颅脑外伤患者诊疗流程的各种风险。改良型FMEA在颅脑外伤患者诊疗流程风险管理中的应用切实可行,该案例可扩展应用到创伤中心医疗流程的风险管理,对于推动创伤中心规范化建设具有重要的实践意义。Objective To explore the applicability of modified Failure Mode and Effects Analysis(mFMEA)in the risk management during the diagnosis and treatment of patients with craniocerebral trauma(CCT),thus providing reference for the standardized management of trauma centers.Methods The mFMEA was developed by incorporating Root Cause Analysis(RCA)into FMEA.With the"diagnosis and treatment processes of patients with CCT"as the subject,the risk priority scores of its failure modes were calculated;subsequently,the failure modes with the top three scores were selected as the key points for RCA,and corresponding preventive and control measures were adopted.The effects were evaluated after 6 months of operation.Results After the intervention,the risk priority scores of these 3 high-risk failure modes decreased significantly;the 24-hour and 7-day mortality rates of patients with CCT also significantly decreased,along with significantly increased improvement rate.Conclusions The intervention plays a role in reducing various risks in the diagnosis and treatment processes of CCT patients.The mFMEA is applicable and feasible in the risk management for the diagnosis and treatment processes of CCT patients.This case can be used to generalize risk management for other medical processes in trauma centers,thereby promoting the standardized operation of such centers.

关 键 词：失效模式与效应分析法 根因分析法 颅脑外伤 诊疗流程 创伤中心 医疗风险管理 

分 类 号：R197.32[医药卫生—卫生事业管理]