Emergency Department (ED) crowding is a problem faced by many healthcare centers. ED can occur as a result of a combination of many issues, including high arrival rates and staffing issues. ED crowding is undesirable since it leads to access issues and further leads to delays in the provision of care (Xu and Chan, 2016) and thus compromises the care quality given (McHugh et al, 2012). Several solutions have been offered as a means of overcoming ED crowding, however, the use of the FMECA tool as a means ot streamlining is proposed within this paper. The paper will utilize the FMECA tool to highlight the potential failure modes and to assist in coming up with preventative tactics.
FMEA
Within the ED, loss will be defined as any delays occurring at the ED. Probability will be valued on a scale of 1 to 10, with a 10 representing highest probability due to highest frequency, while a 1 represents remotest probability. Severity will also be measured by a 1-10 scale with a 10 representing a catastrophic severity and a 1 representing minor severity. Occurrence will be measured by a scale of 1 to 5, with 1 representing least occurrence and 5 being the maximum.
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Rank Prioritization Number (RPN) = Probability * Severity * Occurrence
The RPN will identify the highest risk factors.
FMECA Spreadsheet
| Subsystem | Event | Mode | Probability | Severity | Occurrence | RPN |
| Greet receptionist | No receptionist | High patient volume | 5 | 9 | 2 | 90 |
| Waiting room 1 | Patient in waiting room | Delay getting to ED | 4 | 8 | 3 | 96 |
| Quick registration | Wrong patient called back | Lack of organization | 2 | 7 | 1 | 14 |
| Waiting room 2 | Patient condition worsens | Excess waiting time | 2 | 8 | 3 | 48 |
| Travel to main ED | Travel to ED | Multiple travel routes | 1 | 4 | 1 | 4 |
| Travel to ED | Patient cannot find proper entrance | Poor signage | 2 | 5 | 2 | 20 |
| Find walking entrance | No access to the entrance | Over crowding | 2 | 8 | 2 | 32 |
Report
From the spreadsheet, the total RPN is 304, with the three highest being the first dealing with receptionist, waiting room 1 before registration and waiting room 2 while waiting to enter ED, which then form the three highest risk factors that require solutions.
Solution
As a means of solution, increase of staff at the reception would assist in increasing efficiency at the entry level (El Sayed et al, 2015: Willoughby and Strenger, 2010). It would also help to decrease waiting time in waiting room 1 since registration of incoming patients would be faster. Additionally, the use of flow charts and other classification methods can help in determining acuity, which would assist in reducing waiting time at the second waiting room. These shortcomings would be overcome by instituting these changes at the healthcare center and would reduce ED crowding substantially.
References
El Sayed, M. J., El-Eid, G. R., Saliba, M., Jabbour, R., & Hitti, E. A. (2015). Improving
emergency department door to doctor time and process reliability: a successful implementation of lean methodology. Medicine , 94 (42).
McHugh, M., VanDyke, K., McClelland, M., & Moss, D. (2012). Improving patient flow and
reducing emergency department crowding: a guide for hospitals.
Willoughby, K. A., Chan, B. T. B., & Strenger, M. (October 01, 2010). Achieving wait time
reduction in the emergency department. Leadership in Health Services, 23, 4, 304-319.
Xu, K., & Chan, C. W. (2016). Using future information to reduce waiting times in the
emergency department via diversion. Manufacturing & Service Operations Management , 18 (3), 314-331.
