Implementing a televisiting program in a tertiary university hospital: Failure modes and effect analysis (FMEA) and solutions for improving patient safety and sustainable care

The World Health Organization (WHO) emphasizes the importance of digital solutions such as telemedicine for improving care quality and safety. Recent surveys reveal the limited adoption in many countries including Italy, particularly in regions with mature healthcare systems. The aim of our study was to identify the critical barriers to the implementation of telemedicine visits and propose robust solutions to mitigate the risks associated with the successful rollout and utilization of sustainable telemedicine. We assessed the introduction of telemedicine services for remote follow-up care for chronic gastrointestinal inflammatory bowel disease (IBD) and measured its impact on the risks of patient hospitalizations. We used the Failure Mode and Effects Analysis (FMEA) method to measure the clinical process and identify potential failures and assigned a Risk Priority Number (RPN) to each step. FMEA is a systematic process that involves selecting defined processes, assembling a multidisciplinary team, and analyzing potential failures by establishing links between failure modes, their effects, and causes. The team included medical and nursing leaders and coordinators, and human factors methodology experts, who mapped the care processes and identified potential failure modes for each process. We ranked the failure modes based on severity, frequency, and detectability, and proposed clinical process redesigns to mitigate or prevent failures that could lead to patient harm. We identified 6 main process phases for introducing a televisiting service for patients with chronic inflammatory bowel disease (IBD). The FMEA risk analysis highlighted the criticalities as steps with the highest priority: failure to conduct the visit due to programming error (RPN 450), failure to send the final report (RPN 390), privacy issues during the visit (RPN 350), and appointment booking problems (RPN 340) at the central booking center. Implementing a telemedicine program requires a comprehensive approach that includes identifying key clinical and organizational issues impacting system usability; targeted training of healthcare staff; developing clear policies and procedures; enhancing digital skills and addressing access concerns among citizens using the system; prioritizing patient care and integrating seamlessly with existing systems within the hospital. The disparities between hospital managers and physicians in evaluating the failure risks highlight the key differences in their risk perceptions. Comparisons with similar cases in the literature are necessary.