by Amanda Brown, RN, MSM, CIC

Part I of this series outlined the power of simple risk assessment to identify, mitigate, and eliminate hazards in the day-to-day operations of a hospital. Parts II and III will present approaches to risk assessment that are more complex and require more attention from multidisciplinary teams.

In this installment, we look at Focused Risk Vulnerability Analysis, a planning tool that predicts the impact that possible events or occurrences might have on a hospital. Hazard Vulnerability Analysis has been used routinely to examine the probability of unpredictable disasters, such as hurricanes, tornadoes, blizzards, and chemical spills. Focused Risk Vulnerability Analysis follows a similar process, but it can be used in other areas. For example, conducting an Infection Control risk assessment through this method provides a way to rate the current impact of a particular organism on patients, so that weaknesses can be highlighted and mitigated.

A Focused Risk Vulnerability Analysis is organized into a simple grid, with three major sections.  Each section requires a rating that corresponds to the anticipated impact that the event would have on the hospital. The three sections include:

  1. The probability of an event’s occurrence
  2. The potential impact on the organization
  3. The current level of preparedness for managing the event

In each section (represented by columns), the vulnerability (represented by a row) is assigned a number based on the level of risk. By multiplying the numbers in each section across a given row, an objective assessment of the risk can be determined.

Consider the following example.

Case Study: Back to Boarding School
A rural hospital was anticipating the opening of a new boarding school in its community. High enrollment at the school suggested that dorm crowding and the spread of communicable diseases may present problems. A Focused Risk Vulnerability Analysis was undertaken in an attempt to predict which organisms might require the hospital to respond. The analysis revealed the following conclusions.

Disease Probability of Occurrence Severity/ Risk Level of Failure Preparedness Risk Score
Tuberculosis 1-Remote 4-Catastrophic 3-Poor 12
Influenza 4-High 2-Moderate 1-Good 8
Meningitis 2-Low 3-Major 2-Fair 12

This analysis showed that while influenza remained a potential health issue in the community, the hospital’s planning activities were likely sufficient to address the risk. However, the analysis also revealed that the hospital was less prepared for tuberculosis (TB) and meningitis, which would pose greater risk due to the close confines of a residential school.

As a result of this analysis, the hospital worked with the school to hold meningitis vaccination events and require TB testing prior to the beginning of school. Returning to the tool, the first two columns for TB and meningitis remained stable, but the levels of preparedness were rescored as 4 and 6, respectively. Without the Focused Risk Vulnerability Analysis, the hidden risk of poor preparedness might have unnoticed.

Other Uses
While current regulations only require vulnerability analysis for infection control and disaster planning, hospitals should consider using this method to assess other events that could take place in the hospital, for instance:

  • Security events (assaults, homicide, rape, theft)
  • Employee injuries (needlestick injuries, falls, back injuries)
  • Sentinel events (surgical fires, suicides, infant abductions)

Ultimately, the goal of any risk assessment is to identify risks and lessen their impact. Thus, the most important element of Focused Risk Vulnerability Analysis is the follow-through. To ensure that overall risk has been reduced, take action to mitigate identified risks and rescore these vulnerabilities accordingly.

This post is the second in a series of three entitled, Choosing the Right Tool for Conducting Hospital Risk Assessments. Stay tuned for Part III: Failure Mode and Effects Analysis.

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