ENT One Day Surgery: critical analysis with the HFMEA method

Abstract

Objectives: Research shows that 51.4% of adverse events in hospitals occur in surgery(1) and that 3-22% of surgical patients experience adverse events? The risk may be even higher when turnover is high and when patients are children, as is often the case in ear, nose and throat surgery. This quality project therefore started in response to requests from physicians in two hospitals in the Flemish part of Belgium. The aim of this study is to use the Healthcare Failure Mode & Effect Analysis method to evaluate the process flow for ear, nose and throat patients, and to redesign the process to enhance patient safety. Methodology: In two One Day Clinics, processes were prospectively analysed using the Healthcare Failure Mode & Effect Analysis method. Results: Similar potential failures were reported in both hospitals. The major failure mode was linked to the absence of an active identity check throughout the process. The process was therefore redesigned by implementing a surgical safety checklist and an active identity check protocol. Although the Healthcare Failure Mode & Effect Analysis is a time-consuming method, this systematic approach by a multidisciplinary team has been found to be useful in detecting failure modes that need immediate safety responses. The involvement of all disciplines and an open safety culture during the procedure were the most important conditions. Conclusions: The Healthcare Failure Mode & Effect Analysis is a useful instrument for detecting the failure modes in this care process.