9/14/2015

InstituteforHealthcareImprovement:FailureModesandEffectsAnalysisToolProcessDataReport

FailureModesandEffectsAnalysis(FMEA)Tool

PatientFlowImprovementTeam
UnitedStates
HospitalCommunity

Aim:ReducetheERWaitTimesby30%inthreemonthsbyimprovepatientflowthroughoutthehospitalsetting.
ReduceLOSinERbyreducingbedwaittimesinICU/Med/Surg\
ReduceLOSinERbyreducingTATfromAncillaryServices
ProcessData
Date:05/25/2009
Step

Description

PatientPresentstoRegistrationinED

FailureMode

Causes

StructualsetupofED.First
CurrentProcess/Setup
toseePtisRegistration
Clerk.Bothneedvisualization
RegistrationandED
Nurse/Triage

Step

Description

RegistrationtoTriage

Effects
NonClinicalPerson
Visualizing/PrioritizingPatient
CareComplaints.Oneperson
workingwithmanypatients
comingtoEDDoor

FailureMode

Causes

Effects

RegistrationClerk(Onlyone
onmostshifts).Nooverflow
backupplan.Noactive
communication.Nohandoff
ofpatienttonurseexcepton
paperinabasket.

LocationofRegistrationand
Triage.Nursenotawareof
pendingpatientstoregister
whomadeneedearly
intervention.Nouseof
overflowregistrationstaff,
thentriagenurse

BottleneckinED.Safety
issuewithotherpending
patientswaitingtobeseen
whileonEDclerkis
registering.

Step

Description

TriageuntilMDSeesPatient

FailureMode

Causes

WideVariationinthe
timeframethatthepatientis
seenbetweenERPhysicians

Onephysiciandoeshavea
DelayinTreatment
heavierloadthanother
IncreaseinERLOS
physicians,however,
organizationonthefrontend
doesplayarolewithregards
tonursingnotificationand
visualsthatthepatientis
ready

Step

Description

EDOrdersforAncillaryProtocolvsMDorders

Effects

FailureMode

Causes

Effects

Noordersareenteredbefore
theancillariesarecalledto
theER
Nohandoffbetweenthe
ancillaries

Nocommunicationtoolor
stratificationofwhich
ancillariesarecalledto
performtestingfirst

Delayinresultsoftesting
IncreaseinoverallERLOS

Step

Description

PrioritizeAncillaryOrderPriority

FailureMode

Causes

Noorganizedfashiontocall
ancillaryfortesting.No
prioritizationmethodology.
Nohandoffbetweenancillary

Lackoforderorganization.
IncreasedLOSinER
Prioritization.Communication Delayingettingtestresults
ofwhenonetestwas
completed

Step

Description

EDorderforRTservicestoRTinED

Effects

Effects

Occ Det Sev RPN Actions

10

10

10 1000 RelocateRegistrationand
Triage.Considerutilizingthe
OPRegistrationAreaforED
andusethecurrent
Registrationareafornursing
Triagewithslightstructural
changeforprivacyConsider
glassseeout/notseein.

Occ Det Sev RPN Actions

8

512 HaveRegisterationBackUP
OverflowPlan
EDRegistrationforfirst
patient.Dayshiftwillbackup
secondregistrationandthird
backupistriagenurse.
RevampTriageareawith
movingEDRegistrationand
putTriageinareawhere
nursecanseeoutbutn

Occ Det Sev RPN Actions

10

360 TriageOrganizationandFlow
ofpatientsthroughtheER.
Reevaluatecurrentflowof
patientsintheER

Occ Det Sev RPN Actions

10

10

800 HandOffandPrioritizationof
ordersandcalltoERLab,
RespiratoryandRadiology
Reprioritizedbasedon
patientcomplaint

Occ Det Sev RPN Actions

10

10

600 OrganizedWhiteboardto
notewhenthetestinghas
beencompletedandresults
back

FailureMode

Causes

TimelyandccordinatedRT
Servicesarenotalways
enteredappropriately.

Lackofcoordinationof
DelayedTreatment
ordersbasedonpatientneed IncreasedLOSinER

10

420 Coordinationofalltesting
betweenancillary

SameasLabandRadiology
TATfromMDtoseepatient
toorders
TriagetoMDseepatients

Multiplecausesoutlinedin
theattachedminutesofthe
FMEAteammeeting.Various
TATforvariousphysicians

10

630 Actionswillbethesamefor
allancillary
GetOrdersupfrontandcall
ancillaryovertheradiofor

IncreasedLOSinER
DelayinDX
DelayinTreatmentforthe
patient

Occ Det Sev RPN Actions

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9/14/2015

InstituteforHealthcareImprovement:FailureModesandEffectsAnalysisToolProcessDataReport
fasterTAT

Step

Description

EDOrderforLabtoLabinED

FailureMode

Causes

Effects

Increaseintakingofforders
MDwritingordersforlabs
Somelabsareautomatic
basedonsymptomsper
medicalstaffapproved
protocol

TimeMDtoseepatientto
writeorders
Triagetimeisnotmonitored
correctly

DelayinLabs
DelayinDiagnoses
IncreaseinLOSinER

Step

Description

EDorderforRadiologytoPttoRadiology

FailureMode

Causes

TimetoTriage
Communication
TimefromTriagetoMD
Phones/Beeperstaketime
seeingpatient
MDOrdersfornursingto
enterintotheSTARsystem
Notificationofancillary
TATforancillarytogettoER

Effects
IncreasedLOS
DelayinRadiologyResults
DelayinDXandDischarge

Step

Description

LabandRTTATfromobtainingspecimentoresultsandforRTblood
gasestoresultsandTXTimes

FailureMode

Causes

Effects

NospecificproofofTATfor
NoautomationinLabandRT. Noguidanceastowherethe
ancillaryprocedures.Needto TATmustbecollected
issuesareoccuringforfinal
monitorTATandreporton
manually.
TAT(OrdertoResponseor
actionstoimprove
Responsetoobtainingthe
specimenorCollectionto
Results)
Step

Description

10

RadiologyTATfromtakingxraytofilm/ultrasound/CTforMDReview

FailureMode

Causes

Effects

TATnotmonitored.Cannot
workontheareasofdelay
withoutmonitoringwherein
theprocessthedelaysare
occuring

NoautomationtocollectTAT
timeinformationfromorder
toresponsetoresults.

DelayinTX
IncreasedLOSinER
Nodirectiontofocus
improvementeffortswithout
TATdatacollectedatall
entrypoints

Step

Description

11

TestResultstoMDDecisiontoAdmit/DC

FailureMode

Causes

NodatacollectedonTAT
fromResultsAvailableuntil
MDDecisiononhowtotreat,
dischargeand/oradmit

Datanotavailable.ProMed
IncreasedLOSpossiblebut
forMDwasdiscontinuedforT novalidationofwhichpoint
Sheet
orpointsinthepatientflow
wasdelayingoverall
timelinessoftreatment,
admissionand/ordischarge

Step

Description

12

TimetoMDDecisiontoDischargetoDischargeofPt

Effects

FailureMode

Causes

Effects

MultipleissueswithTATas
farasoncedecisionismade
todischarge,howefficientis
thedischargeprocessinthe
ED.NotificationTimeuntil
Discharge?Instructions.
BarrierstoDischarge.Psych
PatientshaveextendedLOS

Noautomaticprocessto
tracktheTATofReadiness
forDischarge/MDorderuntil
finalDischargeoutofthe
system

IncreaseoverallLOS
DecreasedPatient
Satisfaction
SatisfactionScoresare
lowestintheSystem

Step

Description

13

TimeOrdertoAdmituntilPttoUnit/Floor

FailureMode

Causes

Effects

BarrierstoAdmissionisthe
numberoneapparentdelay
andcauseofincreasedLOS.
Noformaldatacollected,
however,resistanceto
admissionwerenotedat
eachERMeeting

Lackofteamworkmentality
onthefloor
Nightshiftappearedtobethe
#1barrierforadmitting
patients.

IncreasedLOS
DecreasedPatient
Satisfaction
NoHandoff
Communication/Limited

Occ Det Sev RPN Actions

10

540 ImprovetheTATofMDto
seepatient
ImprovetheTATforTriage
Improvecoordinationof
ancillarytesting

Occ Det Sev RPN Actions

10

630 UseRadioforcommunication
tocometoER
Coordinatewithallother
ancillary
EducateRadiologyregarding
TATandexpectations

Occ Det Sev RPN Actions

10

10

800 StartcollectingTATfor
responsetoEDandTATfor
specimentoresultsReport
atweeklymeetings
Improvementswillbenoted
intheminutes

Occ Det Sev RPN Actions

10

10

800 Startcollectionofdatafor
TATatallentrypointsorder
toresponse.Responseto
FilmFilmtoresults

Occ Det Sev RPN Actions

10

10

800 StartDatacollectionatall
pointsofcareintheEDand
reportontheTATintheED
forallareas

Occ Det Sev RPN Actions

10

10

500 MonitortheTATfromMD
dischargetimeuntilpatient
finaldisposition.Actionsare
notedintheFMEATeam
MeetingMinutes
PatientFlowTATFlowsheets
arereviewedeachmeeting
SeeAttached

Occ Det Sev RPN Actions

10

10

900 Accountabilitybythe
managersfortheirstaffin
theexpectationthata
patientneedingadmitted
waspriorityandthatthey
wouldbeadmittedandhand
offperformedinatimely
andaccuratemanner
SeeActionsinTeamMinutes

CalculatedTotals
TotalRiskPriorityNumberfortheprocess

9292

Occ: LikelihoodofOccurrence(110)
Det: LikelihoodofDetection(110)
NOTE: 1=VerylikelyitWILLbedetected

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InstituteforHealthcareImprovement:FailureModesandEffectsAnalysisToolProcessDataReport

10=VerylikelyitWILLNOTbedetected
Sev: Severity(110)
RPN:RiskPriorityNumber(OccDetSev)

Annotation
None

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