Failure Mode and Effects Analysis (FMEA) is an engineering methodology that can be applied to neurocritical care to reduce errors in communication during inter-hospital transfer for acute neurological emergencies. We describe the application of FMEA in our institution as evidence for this methodology to proactively reduce errors in acute neurological patient care.

The origin of the approach dates to the 1940s when the US military investigated failures of their systems; subsequently, FMEA spread to aerospace, automotive and healthcare industries for qualitative reliability analyses; in fact, the Joint Commission now requires hospitals to perform FMEA regularly as a model for QI. However, the application of FMEA as an approach to reduce the safety risks in acute neurological care has not been described.

Here we apply FMEA to identify factors of potential hazards in communication for inter-hospital transfers of intracranial hemorrhages.
1) Assemble a multidisciplinary team
2) Define all functions/potential failure modes for each
3) Identify/assess failure mode severity, occurrence, detectability
4) Prioritize high-risk failures, develop interventions
5) Monitor for sustainability, reevaluate

This intervention resulted in reductions in ED throughput (length of stay: 300 to 149 minutes, (p<.01), significant improvements in inter-disciplinary communication, as seen by an increase from pre-intervention (10%) to post- (64%) where NICU and ED attendings discussed the patient prior to arrival, improved guideline adherence, also with anticoagulant reversal agents administered faster, (217 to 165 minutes), though this was not significant (p = 0.53).

Reducing errors in healthcare delivery often requires a redesign of care processes. QI has traditionally been a reactive process; FMEA exemplifies a proactive investigation of hazards prior to patient harm. When embraced this approach may generate solutions easily translated into institutional guidelines and policies. Utilization of FMEA as an instrument of change is a powerful tool for improving timely communication, resource utilization, and patient outcomes.