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      Evaluating Surgical Risk Using FMEA and MULTIMOORA Methods under a Single-Valued Trapezoidal Neutrosophic Environment

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          Abstract

          Background

          Human errors during operations may seriously threaten patient recovery and safety and affect the doctor–patient relationship. Therefore, risk evaluation of the surgical process is critical. Risk evaluation by failure mode and effect analysis (FMEA) is a prospective technology that can identify and evaluate potential failure modes in the surgical process to ensure surgical quality and patient safety. In this study, a hybrid surgical risk–evaluation model was proposed using FMEA and multiobjective optimization on the basis of ratio analysis plus full multiplicative form (MULTIMOORA) method under a single-valued trapezoidal neutrosophic environment. This work aimed to determine the most critical risk points during the surgical process and analyze corresponding solutions.

          Methods

          A team for FMEA was established from domain experts from different departments in a hospital in Hunan Province. Single-valued trapezoidal neutrosophic numbers (SVTNNs) were used to evaluate potential risk factors in the surgical process. Cmprehensive weights combining subjective and objective weights were determined by the best–worst method and entropy method to differentiate the importance of risk factors. The SVTNN–MULTIMOORA method was utilized to calculate the risk-priority order of failure modes in a surgical process.

          Results

          The hybrid FMEA model under the SVTNN–MULTIMOORA method was used to calculate the ranking of severity of 21 failure modes in the surgical process. An unclear diagnosis is the most critical failure in the surgical process of a hospital in Hunan Province.

          Conclusion

          The proposed model can identify and evaluate the most critical potential failure modes of the surgical process effectively. In addition, such a model can help hospitals to reduce surgical risk and improve the safety of surgery.

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          Most cited references71

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          Best-worst multi-criteria decision-making method

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            Best-worst multi-criteria decision-making method: Some properties and a linear model

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              Incidence and types of adverse events and negligent care in Utah and Colorado.

              The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992. We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event. The measures were adverse events and negligent adverse events. Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent). The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.
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                Author and article information

                Journal
                Risk Manag Healthc Policy
                Risk Manag Healthc Policy
                RMHP
                rmhp
                Risk Management and Healthcare Policy
                Dove
                1179-1594
                23 July 2020
                2020
                : 13
                : 865-881
                Affiliations
                [1 ]School of Business, Hunan University of Science and Technology , Xiangtan 411201, People’s Republic of China
                [2 ]Hunan Engineering Research Center of Intelligent Decision Making and Big Data on Industrial Development , Xiangtan 411201, People’s Republic of China
                [3 ]Xiangya Hospital, Central South University , Changsha 410008, People’s Republic of China
                [4 ]Xiangya Nursing School, Central South University , Changsha 410011, People’s Republic of China
                [5 ]School of Business, Central South University , Changsha 410083, People’s Republic of China
                Author notes
                Correspondence: Ji-Qun He Xiangya Hospital, Central South University , Changsha, People’s Republic of China Email cshejiqun@126.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0001-6121-1002
                http://orcid.org/0000-0002-7997-0012
                Article
                243331
                10.2147/RMHP.S243331
                7384878
                f98c1e6e-532e-4489-b31c-940e9fc96fcf
                © 2020 Cheng et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 22 December 2019
                : 23 June 2020
                Page count
                Figures: 4, Tables: 9, References: 75, Pages: 17
                Categories
                Original Research

                Social policy & Welfare
                failure mode and effect analysis,surgical process,multimoora,best–worst method,single-valued trapezoidal neutrosophic numbers

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