Analysis of 5 years of morbidity and mortality conferences in a metropolitan South African trauma service

Abstract

Background. Since 2008 the Pietermaritzburg Metropolitan Trauma Service (PMTS) has run a structured, self-reporting, metropolitan morbidity and mortality conference (MMC). In 2012 a hybrid electronic medical registry (HEMR) was introduced to capture routine data and to generate reports on morbidity and mortality. This paper reviews our experience in setting up a metropolitan MMC and compares the quality of the reported morbidity data from the pre-and post-HEMR era. Methods. We compared data from the MMC before and after the introduction of the HEMR to audit the impact of these meetings on the reporting and analysis of surgical morbidity and mortality in our service. Results. During the 4-year period from 2008 to 2011, a total of 208 MMCs were held. A total of 10 682 patients were admitted by the PMTS during that period, of whom 87% were males, and the mean age was 26 years. Penetrating trauma accounted for 40.9% (4 344/10 628) of the total workload. A total of 432 (4.1%) morbidities were identified. Of these, 36.6% (158) were related to human error, 32% (138/432) were related to surgical pathologies and the remaining 31.9% (136/432) were related to systemic diseases. There was an exponential increase in the reporting of morbidity each year. The total in-hospital mortality was 3% (358/10 682). Following the introduction of the HEMR, from 2012 to 2014, 6 217 patients were admitted. A total of 1 314 (21.1%) adverse events and 315 (5.1%) deaths were recorded by the HEMR. The adverse events were divided into 875 'pathology-related' morbidities and 439 'error-related' morbidities. Conclusions. The development of the MMC led to increased reporting of morbidity and mortality. The introduction of the HEMR resulted in a dramatic improvement in the capturing of morbidity and mortality data, suggesting that a paper-based self-reporting system tends to underestimate morbidity. Over one-third of all morbidities were related to human error. Common morbidities have been identified.

A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal

“…The majority of the patients experiencing nursing-related morbidities were general surgery patients as these were the majority of the patients who were admitted to the service during the study period. The results showed that more males than females experienced nursing-related morbidities and this is in keeping with the results of a study by Kong and Clarke (2016).…”

“…The incident rate of 3.7% of nursing-related morbidity is consistent with the estimated rate of 2.5% to 18.4% found by Wilson et al (2012) in developing countries (including South Africa). Kong and Clarke (2016) reported an incident rate of 4.1% morbidities during a 5-year analysis of morbidity and mortality conferences in a South African trauma service. However, the incident rate of the current study is lower than the findings of 12.7% in the low- to middle-income countries revealed by Jha et al (2013).…”

“…This has led to greater emphasis being placed on the recognition of adverse events and on systematic efforts to prevent and reduce the incidence and impact of these adverse events on patients. Patient safety is one of the important concepts in the field of health care globally and a key factor in ensuring provision of quality health care (Kong & Clarke 2016). Health care is expected to be delivered safely and effectively by health care professionals.…”

Morbidity and mortality conferences in general surgery: a narrative systematic review

“…Electronic database used to identify cases Auspitz et al, 19 Cromeens et al, 20 Gurien et al, 17 Hutter et al, 18 Kong and Clarke 34 Moderator selects cases Bhalla et al 32 Prospective proforma McVeigh et al 21 Attendance Improved faculty and resident attendance Teleconferencing Falcone and Watson, 38 Lewis et al 37 Morning meeting time Murayama et al 30 Dissemination Established systematic dissemination strategy Post-MMC newsletter Bhalla et al 32 PDCA cycle Vogel et al 40 Surgeon report cards Antonacci et al 41 MMC = morbidity and mortality conference; PDCA = plan-do-check-act; SBAR = situation, background, assessment, recommendation.…”

Demographic, Clinical Features and Outcome Determinants of Thoracic Trauma in Sri Lanka: A Multicentre Prospective Cohort Study

“…Regardless of the devastating complications associated with thoracic trauma, timely diagnosis and proper management can significantly reduce morbidity and mortality [9,10]. Accurate diagnosis of thoracic trauma depends on a high degree of suspicion and pattern recognition [11].…”