Using Failure Mode and Effect Analysis to Identify Potential Failures in a Psychiatric Hospital Emergency Department.

OBJECTIVES: Failure mode and effect analysis (FMEA) is a powerful tool for accessing potential failures, but the participants are limited. It has not been used in psychiatric hospitals. Objectives were to implement FMEA in a psychiatric hospital and determine whether the FMEA process can be expanded by including participants who are familiar with the emergency department (ED) admission process and those who are not. METHODS: In this prospective, questionnaire-based study, a multidisciplinary team experienced in ED admissions was trained in FMEA and determined potential failures in the process. They developed a questionnaire regarding the failures, which were ranked by 17 ED and 28 non-ED healthcare providers. Risk priority numbers were calculated for each. RESULTS: By applying FMEA, we found 6 steps of the ED admission process, with 32 potential failures. Risk priority numbers ranged from 91 to 225. The most notable potential failure identified was during a patient's initial telephone call to the ED, before arrival. Emergency department and non-ED workers ranked 94% of the potential failures similarly. CONCLUSIONS: Failure mode and effect analysis can be implemented in psychiatric hospitals and can be a useful tool for anticipating potential failures. The number of participants in an FMEA can be increased to include those who are not directly involved in the process and should involve several specialists from diverse fields. Increasing the number of participants allows more detailed analyses. A checklist detailing the actions to take when processing a patient's initial phone call should be implemented to decrease hazards related to ED admissions.