Abstract
Patients offered fluid two-hours preoperatively have improved satisfaction, fewer complications and no increased intra-operative risk. Our hospital has prolonged pre-operative starvation times for trauma patients. Failure-Modes-and-Effects-Analysis (FMEA) was used to identify points of inefficiency in the preoperative starvation system.
Data was collected from patients, ward-staff and computer-systems, on pre-operative starvation times and food provision following cancellation. A process map of the system was created. Failure-modes-and-effects were identified at interview and stakeholders were asked to risk-evaluate each failure-mode by providing consequence scores, probability of failure and of detection.
Over 7-days, 27 patients were reviewed. Average fasting times were 6.84 (2–22.25) hours for fluid, and 12.03 (3–28.75) hours for food. Five patients were cancelled with a mean NMB time of 17.25 (3–28.75) hours. The highest risk scores identified were regarding the decision to place a patient on the list (10), keeping patients NBM (10.16) and being cancelled and fed (10.11).
Process-mapping and FMEA can be applied to the pre-operative starvation of trauma patients to identify parts of the system that will have the biggest impact if improved. Engaging the multidisciplinary-team allowed all members to feel involved in risk assessment and quality improvement. Using FMEA should facilitate change and improve the system of pre-operative starvation.
