Failure mode effects and criticality analysis: Innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation

Emilie S. Powell, Lanty M. O'Connor, Anna P. Nannicelli, Lisa T. Barker, Rahul K. Khare, Nicholas P. Seivert, Jane L. Holl, John A. Vozenilek

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Sepsis is an increasing problem in the practice of emergency medicine as the prevalence is increasing and optimal care to reduce mortality requires significant resources and time. Evidence-based septic shock resuscitation strategies exist, and rely on appropriate recognition and diagnosis, but variation in adherence to the recommendations and therefore outcomes remains. Our objective was to perform a multi-institutional prospective risk-assessment, using failure mode effects and criticality analysis (FMECA), to identify high-risk failures in ED sepsis resuscitation. Methods: We conducted a FMECA, which prospectively identifies critical areas for improvement in systems and processes of care, across three diverse hospitals. A multidisciplinary group of participants described the process of emergency department (ED) sepsis resuscitation to then create a comprehensive map and table listing all process steps and identified process failures. High-risk failures in sepsis resuscitation from each of the institutions were compiled to identify common high-risk failures. Results: Common high-risk failures included limited availability of equipment to place the central venous catheter and conduct invasive monitoring, and cognitive overload leading to errors in decision-making. Additionally, we identified great variability in care processes across institutions. Discussion: Several common high-risk failures in sepsis care exist: a disparity in resources available across hospitals, a lack of adherence to the invasive components of care, and cognitive barriers that affect expert clinicians' decision-making capabilities. Future work may concentrate on dissemination of non-invasive alternatives and overcoming cognitive barriers in diagnosis and knowledge translation.

Original languageEnglish (US)
Pages (from-to)173-181
Number of pages9
JournalDiagnosis
Volume1
Issue number2
DOIs
StatePublished - Jun 2 2014

Keywords

  • Cognition
  • Health services research
  • Risk assessment
  • Sepsis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Biochemistry, medical
  • Health Policy
  • Clinical Biochemistry
  • Medicine (miscellaneous)

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