Nursing Risk Management in Emergency SAH Surgery Using Healthcare Failure Mode and Effect Analysis(HFMEA)

Application of Healthcare Failure Mode and Effect Analysis in Nursing Risk Management of Emergency Surgery for Patients With Spontaneous Subarachnoid Hemorrhage

The investigators are testing whether a new nurse-led safety program (HFMEA) lowers problems during emergency brain-aneurysm surgery better than usual care.

Adults with a sudden brain bleed (subarachnoid hemorrhage) who need urgent clipping or coil placement at the hospital are randomly placed in one of two groups:

Usual nursing care, or Usual care plus HFMEA (nurses use checklists to spot and prevent risks such as re-bleeding, high brain pressure, infection, seizures).

The investigators count how often any nursing-related problems happen within 30 days after surgery, how long patients stay, and how satisfied the participants and their families are.

Results will show if this extra safety program should become standard practice.

A single-center randomized trial of adults patients undergoing emergency repair for ruptured brain aneurysms was trying to determing that if proactive "Healthcare Failure Mode and Effect Analysis" (HFMEA) could lower the rate of nursing-related adverse events from 1 in 5 patients to fewer than 1 in 15.

Nurses trained in HFMEA mapped every step of care-from arrival through discharge-identified the 12 highest-risk moments (e.g., delayed pressure checks, missed re-bleeding signs), and built checklists, alert thresholds, and team huddles to stop problems before they started.

aim: adding a structured, forward-looking safety drill to routine neuro-critical nursing appears to spare two out of every three avoidable complications after emergency "brain-aneurysm" surgery without extra technology or cost.

Inclusion Criteria:

1. sSAH confirmed by head CT and/or CT angiography (CTA) or digital subtraction angiography (DSA), with identified intracranial aneurysm;
2. Age 18-75 years;
3. Time from onset to admission ≤72 hours;
4. Undergoing emergency surgical treatment (open aneurysm clipping or endovascular coiling);
5. Hunt-Hess grade I-V;
6. Patient or family consent to participate in the study with signed informed consent.

Exclusion Criteria:

1. Traumatic subarachnoid hemorrhage;
2. Concurrent other intracranial diseases (e.g., brain tumors, arteriovenous malformations);
3. Severe cardiac, hepatic, or renal dysfunction;
4. Coagulation disorders;
5. History of psychiatric disorders or cognitive impairment;
6. Pregnancy or lactation;
7. Transfer to another hospital or treatment withdrawal.