Assessment of the usefulness and feasibility of implementing the spaghetti diagram, Ishikawa diagram, and the HFMEA analysis in a hospital emergency department – a pilot study

Aim. The aim of the study was to assess the feasibility of using the spaghetti diagram, the Ishikawa diagram and the HFMEA analysis to identify problems and risks, their causes, bottlenecks and waste in processes considered to be crucial by emergency department staff. Material and methods. The research was carried out at the University Clinical Hospital in Opole. The following methods used included face-to-face interviews, observation of processes during gemba walks, the development of the spaghetti diagram, the Ishikawa diagram and the use of healthcare failure mode and effect analysis (HFMEA). Results. The study inculded two key processes: triage (according to15 nurses and 10 paramedics) and transferring of emergency department (ED) rooms between shifts (according to 10 nurses and 12 paramedics). The spaghetti diagram showed waste of staff time wasted on searching for a cell phone and going to the sink to moisten gauze pads needed for an electrocardiographic examination. The HFMEA analysis shows staff and equipment shortages, lack of management knowledge about problems occurring in the processes and a training deficit as potential causes of these problems. Conclusions. The implementation of tools and solutions discussed in this paper is possible in emergency department and can provide errors risk reduction.