Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis.

Area of Science:

• Health Services Research
• Emergency Medicine
• Healthcare Management

Background:

• Helicopter Emergency Medical Services (HEMS) overtriage (OT) presents substantial challenges for healthcare systems and stakeholders.
• Understanding the factors contributing to OT and its consequences is crucial for optimizing HEMS utilization.

Purpose of the Study:

• To identify factors associated with overtriage in HEMS interfacility transports.
• To determine the downstream effects of HEMS overtriage.
• To pinpoint areas for improvement in HEMS interfacility transport processes.

Main Methods:

• A Failure Mode and Effects Analysis (FMEA) was conducted to evaluate the HEMS interfacility transport process.
• Data were gathered from organizational finances and three key stakeholder groups: interfacility patients (n=149), flight registered nurses (n=19), and referring emergency medicine providers (EMPs) (n=30).
• FMEA identified failure modes, their frequency and severity, and calculated Risk Profile Numbers (RPNs).

Main Results:

• Twelve failure modes were identified, with 30 potential causes.
• Leading causes of overtriage included inappropriate HEMS requests by EMPs (RPN=343) and inappropriate activation by EMS (RPN=343).
• Minimizing patient/family involvement in decision-making (RPN=315) was also a significant factor, leading to financial burdens and reduced nurse satisfaction.

Conclusions:

• Factors contributing to HEMS interfacility overtriage include practices of referring providers and EMS, HEMS operational processes, and shared decision-making.
• Addressing these factors can help reduce regional overtriage rates.
• Improvements in HEMS utilization require a multi-faceted approach involving providers, EMS, and patient-centered decision-making.