Experiences of hospital move are limited and present some similarities with emergency situations. Hospital preparedness is thus of utmost importance to guarantee patient safety. In autumn 2019, six Swiss hospitals will be relocated within four weeks in a unique 400 beds building. The purpose of this study is to anticipate failures with a potential impact on patient safety during hospital move and hospital evacuation using Failure Modes, Effects and Criticality Analysis (FMECA).
FMECA was carried out by a multidisciplinary team within both internal medicine (IMU) and intensive care units (ICU) for hospital move and evacuation processes. Criticality indexes (CI) were based on the Williams matrix (CImax 810). The 20% of most critical failure modes (Pareto’s rule) were analysed and mitigations were proposed.
59 failures modes for hospital move and 68 for evacuation were identified in both units. Of them, 12 and 14 failures mode were deeply analysed, respectively. Average initial CI for hospital move were 160 (min 105-max 294) for IMU and 201 (125-343) for ICU, which decreased to 32 (-80%) and 49 (-76%) after mitigations. For evacuation, average initial CI were 319 (245-504) for IMU and 592 (441-810) for ICU, which decreased to 194 (-39%) and 282 (-52%). Most mitigation (checklist, medication handling protocol, medical checkpoint, and logistic support) could be implemented for both situations. Only some actions were specific to evacuation process, due to its unpredictable nature.
This study highlights the value of FMECA to anticipate negative patient impact during hospital move or evacuation. Moreover, the preparation of a hospital move could bring useful knowledge and give the opportunity to test the mitigation actions and to include them in evacuation procedures.