[Modal analysis of failures and effects in intra-hospital transfers]

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Clinical Operations Management

Background:

• Intra-hospital patient transfers are complex processes with inherent risks.
• Identifying and mitigating patient safety vulnerabilities during transfers is crucial for quality healthcare.

Purpose of the Study:

• To systematically identify and analyze patient safety gaps during intra-hospital transfers.
• To quantify the risks associated with identified failure modes in patient transfers.
• To develop targeted improvement strategies for enhancing patient safety during internal hospital movements.

Main Methods:

• A working group was established to identify all types of intra-hospital patient transfers.
• Failure Mode and Effects Analysis (FMEA) was employed to assess risks.
• Risk Prioritization Index (RPI) was used to quantify failure mode risks, with scores >100 triggering improvement measures.

Main Results:

• A total of 31 critical points leading to failures or deficiencies were identified across 20 different types of patient transfers.
• 35 specific safety improvement measures were proposed for patient transfers within various hospital areas.
• The FMEA methodology effectively objectified risks, providing data for prioritizing interventions.

Conclusions:

• Failure Mode and Effects Analysis (FMEA) is a valuable tool for objectively assessing patient safety risks during intra-hospital transfers.
• The study provides a data-driven foundation for prioritizing and implementing safety enhancement strategies.
• Proactive risk identification and mitigation are essential for improving patient safety during internal hospital transfers.