Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

Thornton, Victoria; Holl, Jane L.; Cline, David; Freiermuth, Caroline E.; Sullivan, Dori Taylor; Tanabe, Paula

doi:10.5811/westjem.2014.4.20489

Cited by 6 publications

(3 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A FMECA is an engineering method, used initially in high‐risk industries such as aerospace and nuclear power, 25 , 26 but increasingly applied to health care. 27 , 28 , 29 , 30 , 31 , 32 A FMECA involves engaging stakeholders to describe and depict the steps and workflows of a process and then to identify, characterize, and rank the safety vulnerabilities or failures of each step in the process in a risk table that permits rank ordering of the failures. FMECAs help to counter most organizations’ common temptation to focus on process solutions for the most evident and visible failures, which may not be the same.…”

Section: Methodsmentioning

confidence: 99%

Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

Holl

Khorzad²,

Zobel

et al. 2021

JAHA

Self Cite

View full text Add to dashboard Cite

Background Patients with acute stroke at non‐ or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door‐in‐door‐out process and its application to solution design. Methods and Results A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure’s frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking. Targets for solution design were selected among the highest‐ranked failures. The failure modes, effects, and criticality analysis process map and risk table were completed during in‐person and virtual sessions. Failure to detect severe stroke/large‐vessel occlusion on arrival at the PSC is the highest‐ranked failure and can lead to a 45‐minute door‐in‐door‐out delay caused by failure to obtain a head computed tomography and computed tomography angiogram together. Lower risk failures include communication problems and delays within the PSC team and across the PSC comprehensive stroke center and paramedic teams. Seven solution prototypes were iteratively designed and address 4 of the 10 highest‐ranked failures. Conclusions The failure modes, effects, and criticality analysis identified and characterized previously unrecognized failures of the door‐in‐door‐out process. Use of a risk‐informed approach for solution design is novel for stroke and should mitigate or eliminate the failures.

show abstract

Section: Methodsmentioning

confidence: 99%

Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

Holl

Khorzad²,

Zobel

et al. 2021

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Data for this project were reported in the context of a two-center QI project. 17 , 18 Details of the project have been published. 17 – 20 Briefly, the project attempted to optimize the treatment of VOC in the ED using best practices, 1 while monitoring healthcare utilization and psychosocial referral needs and practices.…”

Section: Methodsmentioning

confidence: 99%

“…In the context of a two-center quality improvement (QI) project designed to implement best practices for the ED management of patients with complications of sickle cell disease, 17 , 18 we had a unique opportunity to prospectively examine the impact of different utilization rates of DH care, and/or EDOU care on rates of hospital admission for patients with sickle cell anemia experiencing VOC. We also had the opportunity to assess ED encounters and hospitalizations for our two cohorts of patients at outside centers within a 20-mile radius of each study site, an aspect of care rarely reported on.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

Cline¹,

Silva

Freiermuth

et al. 2018

WestJEM

Self Cite

View full text Add to dashboard Cite

IntroductionUse of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates.MethodsIn the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions.ResultsOver 30 months 427 patients (297 at Site 1 and 130 at Site 2) initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2), and a high of 152 (5/month) acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011) and have an ED visit (96.9% vs. 85.5%, p=0.0002). DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2), and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center.ConclusionIn this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease observation VOC protocol. One-third of patients sampled visited hospitals for acute care outside of their care providers’ institutions.

show abstract

A Prospective Emergency Department Quality Improvement Project to Improve the Treatment of Vaso-Occlusive Crisis in Sickle Cell Disease: Lessons Learned

Tanabe¹,

Freiermuth²,

Cline³

et al. 2017

The Joint Commission Journal on Quality and Patient Safety

View full text Add to dashboard Cite

Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

Cited by 6 publications

References 40 publications

Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

A Prospective Emergency Department Quality Improvement Project to Improve the Treatment of Vaso-Occlusive Crisis in Sickle Cell Disease: Lessons Learned

Contact Info

Product

Resources

About