احسان ثقه ای

An overview of the statistics published by various international organizations in various fields of health risk assessment، shows that medical errors (errors in diagnosis، prescription، treatment)، and system management in hospitals and medical centers have important roles in imposition of high costs and increasing rates of injury and death in the world. Heart disease، as the leading cause of death in industrialized countries and the second leading cause of death in Iran has always been a controversial topic for researchers in the treatment area. Due to the potential risk of this area، the occurrence of any error even small errors is a big risk that could ultimately endanger patients'' lives and incur costs to patients and hospitals. This paper attempted to identify، classify and evaluate the failures in open heart surgery using Healthcare Failure Mode and effect analysis (HFMEA) technique and present some solutions in order to control and reduce these failures. U sing the HFMEA، the open heart surgery process was reviewed and four processes، 22 sub-processes، and 82 activities، and 160 risks for these activities were extracted. Besides، the reasons of failures were determined and four failure modes were identified as the most important ones using qualitative and quantitative analysis and solutions were presented for them. Incomplete visit and injury of the saphenous nerve were extracted as the failure modes occurred due to inattention of examiner and incomplete examination and similarity of saphenous nerve and vessel causes injury of the saphenous. Tariff changes and the maneuvers of the second evaluator were proposed strategies to reduce failures mentioned before. Also wrong adaption of coronary with angiography and wrong estimation of the vessels length were two other identified failure modes. The lack of accurate angiography interpretation and carelessness of the surgeon and surgeon assisting in measuring the vessel’s length were the root causes of failures، respectively. Solutions such as performing angiography in multiple views and in a three-dimensional way (3D)، and also measuring the length of vessel using angiography were suggested solutions to reduce these failures. In open-heart surgery، such as inaccurate documentation، inadequate patient justification and lack of modern facilities to identify the precise and explicit situation seems obvious factors.

Due to the high rate of road accidents in Iran, rescue and relief operations in road are important in health system. Applying some techniques in order to reduce failure in these processes will lead to an increased quality of services; also cost reduction and health improvement will be some consequences. Some of the main Safety Management System elements including hazards and risk identification, assessment, and control them. This paper aimed to determine the optimal processes and relief and rescue operations in roads and also to assess and analyze the failure of this filed; and finally provide some solutions to reduce them. In this applicable and qualitative study, it was used of Health Care Failure Mode and Effect Analysis (HFMEA) in order to identify and analyze the potential errors and failure in relief and rescue operations in road accidents. The relief and rescue operations in road accidents were divided into two processes, 12 sub-processors, and also 53 activities. Each activity probable errors and failures was analyzed and identified; a total of 147 errors were determined and analyzed in both processes and their potential reasons were investigated. Among identified errors, 48 percent were related to manpower; 24 percent equipment malfunction; 11 percent method and process, and the rest was related to other cases such as system, environment, etc based on the results. The issues raised in the article can preserve basic information for future safety studies in relief and rescue operations in road accidents; provide preventive measures and also minimize the likelihood of errors and their consequences.