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Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning.

Methods:: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation.

Results:: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation.

Conclusion:: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps.

No MeSH data available.


Process map displaying the workflow for discharge activities on an inpatient cardiology unit. MD indicates physician, and APC indicates advance practice clinician.
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ocw083-F1: Process map displaying the workflow for discharge activities on an inpatient cardiology unit. MD indicates physician, and APC indicates advance practice clinician.

Mentions: While the process map includes the entire cardiology unit process from admission to discharge, this study only focuses on the discharge process from the inpatient cardiology unit. Standard FMEA protocol requires a defined high-risk process with clear boundaries.2 Clinical partners in the cardiology unit identified discharge as a high-risk process of interest to them that aligned with broader hospital initiatives. Cardiology unit staff identified the discharge activities from the process map to include in this study. Figure 1 displays the process map for the entire workflow from admission to discharge on an inpatient cardiology unit, as well as the process map with discharge activities used in this study isolated.Figure 1.


Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification
Process map displaying the workflow for discharge activities on an inpatient cardiology unit. MD indicates physician, and APC indicates advance practice clinician.
© Copyright Policy - cc-by-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391722&req=5

ocw083-F1: Process map displaying the workflow for discharge activities on an inpatient cardiology unit. MD indicates physician, and APC indicates advance practice clinician.
Mentions: While the process map includes the entire cardiology unit process from admission to discharge, this study only focuses on the discharge process from the inpatient cardiology unit. Standard FMEA protocol requires a defined high-risk process with clear boundaries.2 Clinical partners in the cardiology unit identified discharge as a high-risk process of interest to them that aligned with broader hospital initiatives. Cardiology unit staff identified the discharge activities from the process map to include in this study. Figure 1 displays the process map for the entire workflow from admission to discharge on an inpatient cardiology unit, as well as the process map with discharge activities used in this study isolated.Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning.

Methods:: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation.

Results:: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation.

Conclusion:: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps.

No MeSH data available.