Background: In health care, proactive risk assessment usually takes the form of Failure Mode and Effects Analysis (FMEA). An applied research firm, four community hospitals, and a community health care alliance in south-central Washington State--as members of the Tri-Cities Patient Safety Coalition (TCPSC)--used proactive risk assessment methods such as event tree analysis (ETA) and hazard identification to assess the risk of adverse events associated with a process or system.
Case studies: (1) ETA of a Mental Health Issue: An assessment was performed to understand the risk presented by emergency department (ED) patients with underlying mental health or substance abuse issues. The study led hospital management to provide training in crisis prevention for staff who might be confronted with similar scenarios. (2) Hazard Identification of Patient-Owned Equipment: Following a postsurgery incident involving patient-owned equipment, equipment brought into the hospital was assessed using a hazard identification checklist. The results led one hospital to bar equipment determined to represent unacceptable potential patient harm. (3) FMEA of Interhospital Patient Transfer: Hospital patients often must be transferred to another community hospital for services (such as diagnostic imaging) and then returned-entailing many handoffs and associated patient safety issues. The FMEA and accompanying process map helped the hospitals design a form that includes patient safety-related information and that requires staff to check the patient's status.
Conclusions: The south-central Washington group has learned that other kinds of proactive risk assessment beyond FMEA that are commonly used by engineers can be used to assess the specific kinds of high-risk processes found in health care.