Failure Modes and Effects Analysis Based on In Situ Simulations: A Methodology to Improve Understanding of Risks and Failures

Health care failure modes and effects analysis (FMEA) is a widely used technique for assessing risk of patient injury by prospectively identifying and prioritizing potential system failures. In this study, we conducted in situ simulations at a major suburban hospital as a novel method to discover latent conditions and active failures and to prioritize these based on the potential severity of risks associated with them. Process failures were analyzed for likelihood, severity, and discoverability of occurrence using the FMEA. We developed a high fidelity simulation by creating scenarios based on actual sentinel events. We then used an event-set model in the scenarios and conducted 10 simulation trials with 200 participants. These data were then categorized and used to create risk priority numbers as part of the FMEA process. Our findings allowed us to identify the primary failure modes and were consistent with the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPSTM training categories.