Application of a proactive risk analysis to emergency department sickle cell care

Victoria L. Thornton*, Jane L. Holl, David M. Cline, Caroline E. Freiermuth, Dori T. Sullivan, Paula Tanabe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Introduction: Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED. Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results: Many "high risk" failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease.

Original languageEnglish (US)
Pages (from-to)446-458
Number of pages13
JournalWestern Journal of Emergency Medicine
Volume15
Issue number4
DOIs
StatePublished - 2014

Keywords

  • Decision support tool
  • ED-SCANS
  • Emergency department
  • Pain management
  • Patient safety
  • Quality improvement
  • Sickle cell disease
  • Vaso-occlusive crisis

ASJC Scopus subject areas

  • Emergency Medicine

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