Risk assessment in hematology ward renovation, a FMEA example in a tertiary hospital in Italy

Abstract

Abstract Background Hospital construction and renovation works cause derangement, increasing mistake rate in healthcare workers and resulting in dust contamination and dispersal of fungal spores that could improve morbidity and mortality in severely immune suppressed patients. The necessary renovation of hematology ward at IRCCS Policlinico San Martino in Genoa, scheduled for February 2020 required a risk assessment to avoid logistical, organizational and clinical problems. Two possible scenarios were proposed: (1) displacement of patients in another building previously used as hematological unit or (2) department split in 2 sections to carry out renovation works in different periods. Risk management of the choice relies on failure mode and effects analysis (FMEA) method, a proactive tool based on risk priority number (RPN) that ranks failure modes in terms of occurrence, severity and detection. Aim of this work is to analyze and compare the two scenarios; a team of experts in Public health with specific skills in risk management and hospital governance used FMEA to single out failure modes and to compute RPN. Methods Thirteen failure modes were combined together in four major possible risks: (a) lengthening waiting times and delay haematopoietic stem cell transplant procedures, (b) exposure to airborne contamination, (c) cross contamination and water contamination, (d) wrong behaviors. RPN was computed for each failure mode. Results Relevant failure modes were: reduction of bedsides in both scenarios (7 bedsides lost in first scenario RPN1 540 vs 9 bedsides lost in second scenario RPN2 630), less air exchange/hour in the first scenario (4/h RPN1 500 vs 6/h RPN2 400) balanced by closeness to the work site in the second scenario(RPN2 500). First scenario total RPN was 2430, second scenario was 3250. Conclusions Using FMEA, we assessed the different risks profile of two scenarios. Although some residual risks persisted, the first scenario shows a lower risk profile for all major risks. Key messages Risk assessment is a key element to better understand hospital problems and improve environmental health in healthcare setting FMEA represents a useful tool to guide hospital manager in difficult choices concerning severely immune suppressed patients.