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Use of Failure Mode and Effect Analysis to Reduce Admission of Asymptomatic COVID-19 Patients to the Adult Emergency Department: An Institutional Experience

Authors Teklewold B, Anteneh D, Kebede D, Gezahegn W

Received 10 October 2020

Accepted for publication 23 December 2020

Published 26 January 2021 Volume 2021:14 Pages 273—282


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Marco Carotenuto

Berhanetsehay Teklewold,1 Dagmawi Anteneh,2 Dawit Kebede,2 Wendmagegn Gezahegn3

1Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Clinical Governance and Quality Improvement Directorate, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Paediatrics and Child Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Correspondence: Berhanetsehay Teklewold
Department of Surgery, St. Paul’s Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia
Tel +251944308583

Background: Failure mode and effect analysis is an important tool to identify failures in a system with its possible cause, effect, and set actions to be implemented proactively before the occurrence of problems. This study tries to identify common failure modes with its possible causes and effect to the health service and to plot actions to be implemented to reduce COVID-19 transmission to clients, staff, and subsequent service compromise from asymptomatic COVID-19 patients visiting the adult emergency department of SPHMMC (non-COVID-19 setup).
Method and Study Design: A multidisciplinary team, representing different divisions of the adult emergency department at St. Paul’s Hospital Millennium Medical College (SPHMMC), was chosen. This team was trained on failure mode and effect analysis and basics of COVID-19, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure, and plan changes in practice.
Results: A total of 22 failure modes and 89 associated causes and effects were identified. Many of these failure modes (12 out of 22) were found in all steps of patient flow and were associated with either due to lack of or failure to apply standard and transmission-based precautions. This suggests the presence of common targets for improvement, particularly in enhancing the safety of staff and clients. As a result of this FMEA, 23 general improvement actions were proposed.
Conclusion: FMEA can be used as a useful tool for anticipating potential failures in the process and proposing improvement actions that could help in reducing secondary transmissions during the pandemic.

Keywords: COVID-19, FMEA, standard precaution

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