arXiv:2603.22978v1 Announce Type: new Abstract: In the maintenance of complex systems, fault trees are used to locate problems and provide targeted solutions. To enable fault trees stored as images to be directly processed by large language models, which can assist in tracking and analyzing malfunctions, we propose a novel textual representation of fault trees. Building on it, we construct a benchmark for multi-turn dialogue systems that emphasizes robust interaction in complex environments, evaluating a model's ability to assist in malfunction localization, which contains $3130$ entries and $40.75$ turns per entry on average. We train an end-to-end model to generate vague information to reflect user behavior and introduce long-range rollback and recovery procedures to simulate user error scenarios, enabling assessment of a model's integrated capabilities in task tracking and error recovery, and Gemini 2.5 pro archives the best performance.

Background: 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. Objective: 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. Methods: 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. Results: 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 (