Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification

Abstract

Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning.Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation.Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation.Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps.

Characterizing Teamwork in Cardiovascular Care Outcomes

“…A low SPOR score does not indicate that a provider has inferior clinical skills; rather, it may reveal previously unrecognized structural or organizational barriers. Clinical workflows and protocols can be overlaid on top of the collaboration network to identify potential problem areas, which we demonstrated in a recent study 29 . These data reviewed periodically by hospital and provider leadership may lend insight into teamwork barriers and allow for construction of interventions to improve collaboration.…”

A comparative risk assessment of dialysis care processes in the home and hospital care contexts

“…Although such knowledge of the clinical process is an important consideration, overreliance on expert knowledge is highlighted as a potential pitfall to assessing risks in a non-biased way. In such cases, bias of the decision makers influences outcomes of the risk assessment using the HFMEA approach (Goodrum and Varkey 2017;Kricke et al 2017;Abrahamsen et al 2016).…”

Process Mapping in Healthcare: A Systematic Review

“…that PM is a tool to break-down the complexity characterizing healthcare, by providing improvement teams with a structured picture of complex processes, using information from process stakeholders holding different roles and perspectives. [35,82,84,90,[92][93][94] Diverse views elicited during PM help improvement teams gain a shared understanding of local practices and underlying systemic issues. For example, PM has been found particularly useful to disaggregate care process and identify costs for each process step [84][85][86][87][88][89] as well as to understand interactions between different parts of healthcare systems.…”

“…For example, in ICP projects the use of PM to understand systems helped to improve coordination of care across different settings and networks [79,81,95], while in FMEA projects it helped to identify potential systems failures. [64,94,[96][97][98][98][99][100][101][102][103][104] (ii) Inform scope, design, development and evaluation of interventions The identi cation of actual constraints and opportunities within local systems helped assessment of problem areas and development of improvement solutions grounded in research evidence and local knowledge. [68,72,74,80,86,90,[105][106][107] The use of PM before the implementation of information systems (IS) to help project members with diverse backgrounds achieve a shared understanding of the system has been reported as crucial for solving design challenges.…”