كاربرد FMEA فازي براي بهبود گردش كار در اتاق‏هاي عمل

Fuzzy FMEA Application to Improve Workflow in Operating Rooms

از آنجايي كه پديده وقفه در اتاق هاي عمل بسيار اتفاق مي افتد، تيم جراحي آن را غيرقابل اجتناب و جزيي از گردش كار تصور مي كند. وقفه، سبب كاهش كارآيي و اتلاف منابع بيمارستاني است و جايگاه برنامه ريزي و زمان بندي را در سازماندهي بهينه مجموعه فعاليت ها خدشه‌دار مي كند. براي كاهش اين پديده و بهبود گردش كار، ابتدا لازم است عوامل وقفه را شناسايي و سپس بر اساس ميزان تاثير آنها در شكست سيستم، رتبه بندي كرد. بدين منظور مي توان از FMEA استفاده كرد كه با كمك شاخص عدد اولويت ريسك، حالات شكست در يك سيستم را ارزيابي مي كند. ولي نحوه محاسبه اين شاخص، انتقادهايي را به همراه دارد كه براي رفع آن، اين روش با تيوري فازي تركيب و رويكرد پيشنهادي در بيمارستان شريعتي پياده سازي شده است. به موقع شروع نشدن اولين عمل جراحي، كمبود تخت و كاركنان ريكاوري، كمبود بيماربرها و خدمه بيماربر و ارتباطات ضعيف پذيرش و اتاق‏هاي عمل به عنوان مهم‌ترين عوامل وقفه اين بيمارستان شناسايي شده اند.

Since interruption is so common in the operating rooms, surgical teams and staff assume that interruption is an inevitable and part of the care process. The interruption in operating room workflow is one of the main causes of inefficiency and hospital waste. Interruption increase operative cost and surgery time. In many cases, interruptions are a resource problem or a flow problem. Accordingly, Operating room management develops and implements various methods for improving workflow. In this paper, a fuzzy-based approach for Failure mode and effect analysis (FMEA) is applied for decrease or prevention of the interruption in surgeries. FMEA is a semi-quantitative structured technique performed using risk priority number (RPN). This method can be suitable in detecting all failure modes within a system, evaluating their impact, and planning the corrective actions. Although this technique has been widely used in many industries and services such as healthcare, it has some challenges in assigning the RPN. In this paper, FMEA is combined with fuzzy theory to overcome the limitations and insufficiencies. The proposed method is implemented in one of the teaching hospitals in Tehran and lack of recovery beds and personnel, lake of transporter and transporter personnel, poor communication between admission and operating room and not operating surgeries on-time are identified as the main causes of the surgical interruption. Compared with the traditional FMEA, fuzzy FMEA can identify failure modes in a system and discover their effects in a more efficient way. So, the hospital management can take corrective actions with more confidence regarding to the limited available resources for allocating to a higher risk of in interruption causes.