Construction of a safe and controllable quality management model for "Internet + Nursing Services" based on HFMEA...

This study aimed to develop and evaluate a healthcare failure mode and effects analysis (HFMEA)-based quality management model for "Internet + Nursing Services" (INS) to enhance service safety, standardization, and stakeholder satisfaction, while assessing its economic impact.

A retrospective controlled study was conducted. Patients receiving INS from January to December 2022 (n = 170) served as the control group, while those receiving services via an HFMEA-optimized platform from January to December 2023 (n = 400) constituted the experimental group. Propensity score matching was applied to ensure baseline comparability. The intervention involved a systematic HFMEA process: (1) multidisciplinary team formation and workflow mapping, (2) identification and risk prioritization (via Risk Priority Number, RPN) of potential failure modes across eight key process nodes, (3) implementation of targeted controls (e.g., automated nurse-patient matching, pre-visit checklists, standardized operating procedures, emergency protocols, and a closed-loop reporting system), and (4) integration with a digital platform for workflow management and data tracking. Primary outcomes were the incidence of adverse events and the rate of unplanned re-visits or clinic visits within 48 h. Secondary outcomes included patient and nurse satisfaction scores, mean RPN (process risk), nursing record completion rate, emergency response timeliness, and direct medical costs associated with adverse events.

The HFMEA-based model significantly improved safety and quality metrics. The adverse event incidence was reduced by 76.8% (1.50% in the experimental group vs. 6.47% in the control group, p = 0.003), and the unplanned revisit rate decreased from 10.6 to 2.25% (p < 0.001). The mean process RPN dropped by approximately 80% (from 172.1 ± 20.8 to 34.6 ± 10.2, p < 0.001). Patient satisfaction increased from 92.0 ± 2.7 to 97.2 ± 2.1 (p < 0.001), and nurse satisfaction rose from 77.0 ± 13.8 to 90.6 ± 8.4 (p < 0.001). Operational efficiency improved, evidenced by a higher nursing record completion rate (98.2% vs. 85.9%) and a 50% reduction in emergency response time (21 vs. 42 min). Structural equation modeling revealed that nurse risk perception mediated 62.5% of the effect of specialized training on patient satisfaction. Economically, the intervention resulted in direct medical cost savings of 16,530 RMB (a 75.6% reduction), averaging 41.3 RMB saved per service case.

The HFMEA-based model was associated with a 76.8% reduction in adverse events, an 80% decrease in RPN, and improved satisfaction. However, causal conclusions are limited by the retrospective, single-center design. Preliminary cost savings were observed, but formal economic evaluation is needed. Replication in diverse settings and future multicenter studies are required.