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

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

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

Exclusion criteria

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