title: Practical implementation of failure mode and effects analysis for safety and efficiency in stereotactic radiosurgery.
abstract: OBJECTIVE
  To improve the safety and efficiency of a new stereotactic radiosurgery program with the application of failure mode and effects analysis (FMEA) performed by a multidisciplinary team of health care professionals.
  
  
  METHODS
  Representatives included physicists, therapists, dosimetrists, oncologists, and administrators. A detailed process tree was created from an initial high-level process tree to facilitate the identification of possible failure modes. Group members were asked to determine failure modes that they considered to be the highest risk before scoring failure modes. Risk priority numbers (RPNs) were determined by each group member individually and then averaged.
  
  
  RESULTS
  A total of 99 failure modes were identified. The 5 failure modes with an RPN above 150 were further analyzed to attempt to reduce these RPNs. Only 1 of the initial items that the group presumed to be high-risk (magnetic resonance imaging laterality reversed) was ranked in these top 5 items. New process controls were put in place to reduce the severity, occurrence, and detectability scores for all of the top 5 failure modes.
  
  
  CONCLUSIONS
  FMEA is a valuable team activity that can assist in the creation or restructuring of a quality assurance program with the aim of improved safety, quality, and efficiency. Performing the FMEA helped group members to see how they fit into the bigger picture of the program, and it served to reduce biases and preconceived notions about which elements of the program were the riskiest.
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: kyounge@med.umich.edu.
authors: Kelly Cooper
authors: KC
authors: Younge
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors: Yizhen
authors: Y
authors: Wang
authors: Department of Radiation Oncology, Trillium Health Partners - Credit Valley Hospital Site, Mississauga Halton/Central West Regional Cancer Program, Mississauga, ON, Canada.
authors: John
authors: J
authors: Thompson
authors: Department of Radiation Oncology, Trillium Health Partners - Credit Valley Hospital Site, Mississauga Halton/Central West Regional Cancer Program, Mississauga, ON, Canada.
authors: Julia
authors: J
authors: Giovinazzo
authors: Department of Radiation Oncology, Trillium Health Partners - Credit Valley Hospital Site, Mississauga Halton/Central West Regional Cancer Program, Mississauga, ON, Canada.
authors: Marisa
authors: M
authors: Finlay
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors: Raxa
authors: R
authors: Sankreacha
mesh_terms: D003663:Decision Trees; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D011336:Probability; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D016634:Radiosurgery / Q000009:adverse effects* / Q000592:standards*; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000379:methods*; D012449:Safety