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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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

  • Medicine(all)

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