Use of a risk analysis method to improve care management for outlying inpatients in a university hospital

Objective: To improve the quality of care provided for inpatients outlying in inappropriate wards of a teaching hospital because of lack of vacant beds in appropriate specialty wards. Methods: A multidisciplinary team consisting of hospital doctors, nurses and managers performed a prospective risk analysis of the process of care provided for outlying patients during their hospitalisation. The design of the study was Failure Modes, Effects and Criticality Analysis (FMECA). Failure modes were defined and classified according to their criticality, in order to identify priority actions for improvement. Criticality indices were calculated by multiplying occurrence, severity and detection scores. Results: Measures for improvement indicated by the most critical failure modes were the identification of specialist doctors in appropriate specialty wards to be responsible for the care of outlying patients falling within their sphere of competence; the identification of a nurse coordinator in each department to improve communication between the emergency department, appropriate specialty wards and outlying wards; the standardisation of medical records throughout the whole hospital to ensure better traceability and access to information. Conclusions: Using FMECA, we were able to identify the most critical failure modes of the complex process of care provided for outlying patients and to suggest subsequent improvement measures. Follow-up indicators were defined to assess implementation.