Investigating the Effect of Hospital Infection Control Informatization on Optimizing Microbiological Specimen Submission Before Antibiotic Therapy: Failure Mode and Effects Analysis

TL;DR

This study shows how combining hospital informatization with FMEA improves pre-antibiotic specimen submission, boosting compliance and reducing antibiotic misuse.

Contribution

The novel integration of FMEA with hospital informatization to optimize microbiological specimen submission workflows in antimicrobial stewardship.

Findings

Top failure modes included barcode scanning failures and inadequate clinical decision support.

Postintervention, specimen submission rates for restricted and special-use antibiotics significantly increased.

Digital tools like AI alerts and automated dashboards enhanced compliance and workflow standardization.

Abstract

Antimicrobial resistance (AMR) poses a critical global health threat, with inappropriate antibiotic use being a major driver. Timely microbiological specimen submission before initiating antibiotic therapy is a cornerstone of antimicrobial stewardship (AMS), enabling pathogen-directed therapy and reducing unnecessary broad-spectrum exposure. However, suboptimal compliance remains common due to workflow interruptions, technological barriers, and behavioral factors. Failure Mode and Effects Analysis (FMEA), a proactive risk-assessment method widely used in health care quality improvement, provides a systematic framework to identify process vulnerabilities and prioritize corrective actions. Despite its increasing application, few studies have integrated FMEA with hospital informatization to optimize microbiological specimen submission workflows in routine AMS practice.

This study aimed to systematically identify workflow risks affecting preantibiotic microbiological specimen submission and to design, implement, and evaluate informatization-enabled interventions using an FMEA-based framework.

FMEA was conducted at a tertiary hospital in China. A multidisciplinary team identified potential failure modes across 4 domains: health information systems, personnel, administration, and external support. Risk Priority Numbers (RPNs) and Action Priority (AP) indices were calculated for each failure mode. Targeted interventions were implemented, including dual-verification barcode scanning, artificial intelligence-driven clinical decision support alerts, EHR-integrated training modules, and automated compliance dashboards. Pre- and postintervention specimen submission rates (January 2024-December 2024) were analyzed using the Mann-Kendall trend test.

The top 5 failure modes included PDA barcode scanning failures (RPN=175), inadequate clinical decision support (RPN=140), insufficient clinician awareness (RPN=56), suboptimal oversight mechanisms, and patient-related barriers. Postintervention, significant upward trends were observed in overall specimen submission rates (P<.001), with similar improvements for restricted-use (P<.001) and special-use antibiotics (P<.001).

FMEA-based risk management combined with hospital informatization effectively optimized specimen submission workflows. Real-time decision support, process standardization, and interdisciplinary collaboration significantly enhanced compliance. Future research should evaluate long-term impacts on AMR reduction and diagnostic integration. Integrating FMEA with hospital informatization effectively strengthened the microbiological specimen submission process. Digital decision support, standardized workflows, and real-time monitoring substantially improved compliance with preantibiotic specimen submission. This approach provides an actionable model for data-driven AMS enhancement. Future studies should assess scalability, cost-effectiveness, and impacts on downstream AMR outcomes.

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