Rationale: Many causes of hospital evacuation exist but published practical experiences are rare, although it’s a high risk event for patient’s safety. The objective of this study was to evaluate risks to improve patient safety during evacuation applying a Failure Modes, Effects and Criticality Analysis (FMECA).
Methods: FMECA was carried out with a multidisciplinary team (physicians, nurses, pharmacists, logistic manager, direction and patient’s safety officer). It has been performed on both internal medicine unit (IMU) and intensive care unit (ICU). Criticality indexes (CI) were based on the Williams matrix (CImax 810). The 20% of most critical failure modes (Pareto’s rule) were analyzed and mitigations actions were proposed.
Results: The team met 3 times (7 hours). 68 failure modes were identified in IMU and ICU. Averages initial CI were 319 (245-504) for IMU and 592 (441-810) for ICU. After mitigations of 14 failure modes, the mean criticality decreased to 194 (mean reduction 39%) and 252 (52%), respectively. The main improvement was the deployment of an “evacuation kit” with necessary documents and equipment (e.g. hospital and evacuation plans, checklist, algorithm for patient triage and evacuation, degraded mode protocols). Degraded mode, call-backs, and evacuation process must be tested regularly and known by the staff. Moreover, collaboration with advanced medical post is essential to ensure drug accessibility if other hospitals are not rapidly reachable. The implementation of “emergency drugs bag” containing vital drugs and antidotes must be considered.
Conclusions: FMECA has shown to be a useful tool to improve evacuation procedures and highlighted the value of evacuation preparedness. Evacuation kit in addition to degraded mode protocols, call-back, and evacuation process should be implemented and known by the staff. Considering the difficulties of anticipation, established plan and flexibility are required.