Proactive risk assessment of the MRI process in Ghaem Hospital, Mashhad (2013)

Pediatric emergency department is a high risk area, and a wide range of imaging errors is probable. The aim of this study was to proactive risk assessment of the MRI process in the pediatric emergency department of Ghaem teaching hospital in Mashhad. This descriptive study was performed in Ghaem hospital, Mashhad during 2013. Failure modes and their effects were identified with Healthcare Failure Mode and Effect Analysis (HFMEA) using a mixed method (quantitative - qualitative). The UK community practice model and an approved model by the UK National Health System were used to classify failure modes and failure mode causes, respectively. The theory of inventive problem solving was used to determine solutions for improvement. 43 failure modes were identified for 13 sub-processes of the six-step MRI process. Four failure modes were considered as high risk (hazard score≥8) and were transferred to the decision tree. The frequency of failure modes were as follow: 40.42% communication errors, 23.40% clinical errors, 17.02% prescription errors, 6.38% patients and their relatives errors, 10.63% equipment errors and 2.12% other errors. Of 68 failure mode causes, the most common causes were related to the communication factors (23.5%), and the least common causes were related to the organization factors (2.9%). The HFMEA method was efficient in identifying failure modes, determining failure mode causes and proposing improvement strategies for the MRI process. Training and auditing were considered as two main tools for optimizing the MRI process in the pediatric emergency department of Ghaem hospital.