Failure Modes and Effects Analysis to Evaluate Discharge Delays of Postoperative Tonsillectomy Patients From the Medical-Surgical PICU.

IF 2.5 4区医学 Q2 HEALTH POLICY & SERVICES Journal of Pediatric Health Care Pub Date : 2025-01-01 Epub Date: 2024-10-10 DOI:10.1016/j.pedhc.2024.09.007

Emily R Hamilton, Marketa Rejtar, Michele DeGrazia, Youyang Yang

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引用次数: 0

Abstract

Background: Discharge delays of Medical-Surgical Pediatric Intensive Care Unit (PICU) patients with Obstructive Sleep Apnea (OSA) following tonsillectomy or tonsillectomy with adenoidectomy (T&A) negatively impact hospital bed availability.

Aim statement: This project identified process improvements to reduce discharge delays and increase PICU bed availability.

Methods: A Failure Modes and Effects Analysis (FMEA) was implemented to identify care and process failures that result in discharge delays.

Intervention: Through the FMEA, failure risk profile numbers with the highest impact were recognized for improvement (Institute for Healthcare Improvement, 2017; VHA National Center for Patient Safety, 2023).

Results: Forty failure modes were identified. High-impact failures included not administering dexamethasone early for patient pain or desaturation, intervening for desaturations consistent with the patient's baseline, and not anticipating family needs for discharge.

Conclusions: The FMEA identified several actionable changes that if implemented, could promote timely discharge of patients with OSA following tonsillectomy or T&A.

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评估扁桃体切除术术后患者从内外科 PICU 出院延迟的故障模式和影响分析。

背景：扁桃体切除术或扁桃体切除加腺样体切除术（T&A）后，内外科儿科重症监护病房（PICU）阻塞性睡眠呼吸暂停（OSA）患者的出院延迟对医院床位的可用性产生了负面影响：该项目确定了改进流程的方法，以减少出院延迟并提高 PICU 病床的可用性：方法：实施故障模式和影响分析（FMEA），以确定导致出院延迟的护理和流程故障：干预措施：通过 FMEA，确认影响最大的故障风险概况编号，以便进行改进（医疗保健改进研究所，2017 年；VHA 国家患者安全中心，2023 年）：结果：确定了 40 种故障模式。影响较大的故障包括：未针对患者疼痛或饱和度降低及早使用地塞米松、未根据患者的基线对饱和度降低进行干预，以及未预见出院时家属的需求：FMEA 确定了几项可行的改进措施，如果实施这些措施，可促进扁桃体切除术或 T&A 术后 OSA 患者及时出院。

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来源期刊

Journal of Pediatric Health Care NURSING-PEDIATRICS

CiteScore

3.40

自引率

10.70%

发文量

140

审稿时长

24 days

期刊介绍： The Journal of Pediatric Health Care, the official journal of the National Association of Pediatric Nurse Practitioners, provides scholarly clinical information and research regarding primary, acute and specialty health care for children of newborn age through young adulthood within a family-centered context. The Journal disseminates multidisciplinary perspectives on evidence-based practice and emerging policy, advocacy and educational issues that are of importance to all healthcare professionals caring for children and their families.