This study proposes a risk analysis approach for complex healthcare processes that combines qualitative and quantitative methods to improve patient safety. We combine Healthcare Failure Mode and Effect Analysis with Computer Simulation (HFMEA-CS), to overcome widely recognized HFMEA drawbacks regarding the reproducibility and validity of the outcomes due to human interpretation, and show the application of this methodology in a complex healthcare setting.HFMEA-CS is applied to analyze drug adherence performance in the surgical admission to discharge process of pheochromocytoma patients. The multidisciplinary team identified and scored the failure modes, and the simulation model supported in prioritization of failure modes, uncovered dependencies between failure modes, and predicted the impact of measures on system behavior.The results show that drug adherence, defined as the percentage of required drugs received at the right time, can be significantly improved with 12%, to reach a drug adherence of 99%.We conclude that HFMEA-CS is both a viable and effective risk analysis approach, combining strengths of expert opinion and quantitative analysis, for analyzing human-system interactions in socio-technical systems.
Pergamon ('hcm~,ai f~mt.wcrl.a .gclenc(.. Vo] Abstraet---A new development in the field of internals in packed columns is the use of structured packing types. Recently, a new structured packing type coated with a thin alumina layer (KATAPAK rM) has been developed, in this report, the results of an experimental and theoretical study concerning the possible applicability of this new packing material for hydrogenation processes in a trickle-bed reactor is presented. The palladium catalyzed hydrogenation of ~-methylstyrene is used as a model reaction to study hydrodynamics and mass transfer characteristics in a trickle-bed reactor under reactive conditions. Conversions at several process conditions are measured in a pilot plant in which 3 mm spheres as well KATAPAK rM is applied as packing materials. A comparison of the results of some physical absorption experiments with the results of hydrogenation experiments showed that the resistances in series model--in which the total resistance against mass transfer is calculated from the separate resistances--is not valid in systems where heterogeneous reactions at the solid surface can enhance the mass transfer-rate at the gas-liquid interphase. With the aid of a developed trickle-bed reactor model, based on liquid diffusion, simultaneous reaction at the solid surface and zero volume mixing points, the mass transfer phenomena in trickle-bed reactors in conditions where the resistances in series model fails can be explained and described. The numerically solved model calculates the hydrogen profiles in the liquid films of the reactor and over all single pass conversions at several process conditions. These conclusions are confirmed by the results of the simulation of a model reactor, i.e. the laminar film reactor with a catalytically active wall. From the results of the measurements it could be concluded that in trickle-flow conditions, the application of KATAPAK TM does not significantly improve on the overall performance of trickle-bed reactors. The increase of the physical absorption rate due to better mass transfer characteristics of structured packings compared to dumped packing types--as reported in literature--will be eliminated to a certain extent in reactive systems due to the enhancement effect of heterogeneous reactions in trickle-tlow operation. (' 1997 Elsevier Science Lid
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