Are morbidity and mortality conferences DNR (Do Not Resuscitate) or can they be revived?

Epstein, Nancy E.

doi:10.4103/2152-7806.101804

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…Compounding the apprehension of an MMC-damaged reputation is the fear of litigation 32,33 . In fact, in states where litigation is possible, MMCs suffer 34 . As a result, clinicians are reluctant to admit and openly discuss an error, which substantially hinders transparency as a critical element underpinning trust with patients and families and the transfer of learning into all effected practices.…”

Section: Assessment Of Problems and Strategies For Improvementmentioning

confidence: 99%

“…32,33 In fact, in states where litigation is possible, MMCs suffer. 34 As a result, clinicians are reluctant to admit and openly discuss an error, which substantially hinders transparency as a critical element underpinning trust with patients and families and the transfer of learning into all effected practices. Consequently, a punitive culture promotes defensiveness, limits discussion, and reduces the openness to feedback.…”

Section: Assessment Of Problems and Strategies For Improvement Challe...mentioning

confidence: 99%

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The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety

et al. 2020

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Since the 20th century, health care institutions have used morbidity and mortality conferences (MMCs) as a forum to discuss complicated cases and fatalities to capitalize on lessons learned. Medical technology, health care processes, and the teams who provide care have evolved over time, but the format of the MMC has remained relatively unchanged. The present article outlines 5 key areas for improvement within the MMC along with prescriptive and actionable recommendations for mitigating these challenges. This work incorporates the contributions of numerous researchers and practitioners from the educational, training, debrief, and health care fields. With the best practices and lessons learned from various domains in mind, we recommend optimizing the MMC by (1) encouraging a culture that leverages expertise from multiple sources, (2) allocating ample time for innovative thinking, (3) using a global approach that considers individual, team, and system-level factors, (4) leveraging learnings from errors as well as near misses, and (5) promoting communication, innovative thinking, and actionable planning. The 5 evidence-based recommendations herein serve to ensure that MMCs are structured learning events that promote, encourage, and support safe, reliable care. Furthermore, the outlined recommendations seek to capitalize upon the MMC's opportunity to engage early discovery as well as proactive risk assessment and action-oriented solutions.B ecause of the prevalence of adverse events, the health care sector has made efforts to improve patient safety and quality care. The morbidity and mortality conference (MMC) is a forum to improve patient care through the disclosure and review of error and near-miss events by analyzing errors to gain insights and extract knowledge to improve care processes and outcomes. 1,2 To elaborate further, MMCs are traditionally regularly scheduled meetings in which select patient case studies and provider-raised issues are reviewed to (1) determine the appropriateness and evidence-base of the clinical provision of care when weighed against accepted best practices, (2) learn from patient cases where errors and complications occurred, and (3) determine whether future errors can be prevented or mitigated by adjusting actions and judgments. [3][4][5][6] Morbidity and mortality conferences are similar to debriefs (i.e., a forum of reflection and planning to improve performance 7 ); that is, participants in debriefs as well as MMCs reflect on a previous experience or case to identify actions, construct meaning, and uncover lessons that can be applied to improve outcomes. 7 Similar to MMCs, properly executed debriefs can improve performance of individuals and teams but only if they achieve their desired objectives. 7 Morbidity and mortality conferences are designed to educate the disciplines based on the experiences of a select, unfortunate few. 8,9 This education, ideally, leads to positively changed clinical practice, 10 and some advocate for increasing the frequency of the MMC. 11 Across health...

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Section: Assessment Of Problems and Strategies For Improvementmentioning

confidence: 99%

Section: Assessment Of Problems and Strategies For Improvement Challe...mentioning

confidence: 99%

The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety

et al. 2020

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“…[6] There were 4 orthopedists and 13 neurosurgeons; 6 were past or present Chairs of Departments (3 of Orthopedics, and 3 of Neurosurgery), and 4 were Directors of Spine Sections. Fourteen were in university practices (12 professors, 1 associate professor, and 1 assistant professor), while 3 were in private practice (2 professors affiliated with universities, and 1 attending physician in private practice).…”

Section: Definition and Handling Of Adverse Events In Mandm Conferencesmentioning

confidence: 99%

Morbidity and mortality conferences: Their educational role and why we should be there

Epstein

2012

Surg Neurol Int

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Background:This article examines the value of morbidity and mortality (M&M) conferences, and the multiple factors that contribute to their efficacy. Physicians’ morbidity and mortality conferences (M&MCs) focus on education by reviewing individual adverse events (AE), M&M. Alternatively, Quality Assurance (QA) conferences better examine system-wide issues (e.g., the role institutions play) in attaining or maintaining acceptable levels of patient care. Other issues examined in this review include: whether prospective vs. retrospective M&M data collection are more accurate, and how most states offer ‘nondiscovery’ of M&M proceedings.Methods:Most studies emphasize the educational role of M&MCs, and differentiate their role from QA. Studies comparing the accuracy of prospective vs. retrospective collection of M&M data were reviewed along with the medicolegal issues surrounding the protection of M&M data (‘nondiscovery’).Results:Multiple review articles emphasized that QA conferences typically identify system-wide failures (e.g., hospital policies) while M&MCs focus on physicians’ AE/morbidity/mortality. Additionally, the prospective collection of M&M data proved to be more accurate than retrospective analysis. Finally, most states protect M&M confidentiality (‘nondisclosure’); a glaring exception is Florida, ‘The Sunshine State,’ that allows ‘full disclosure.’Conclusion:This study reviews how M&MCs, differentiated from QA meetings, and educate physicians. It also documents how prospective collection of M&M data is more accurate than retrospective analysis. Additionally, it documents how in most states, medicolegal protections against discovery are in place, with Florida, the ‘Sunshine State’ remaining a glaring exception.

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“…The MMC holds a historical place in the development of professional ethics in medicine, and it will be intriguing to see how the role, format, and structure of the conference evolves to meet the demands and pressures of current PICU life (fail ure to evolve is not really an option) (16). Future studies will also need to widen the focus to include the perceptions and concerns of the extended PICU team including nurses, clinical technologist, and (possibly) parents and families.…”

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confidence: 99%

Safety and Quality as a “Way of Life” in the PICU

Argent¹

2014

Critical Care Medicine

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Are morbidity and mortality conferences DNR (Do Not Resuscitate) or can they be revived?

Cited by 6 publications

References 6 publications

The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety

The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety

Morbidity and mortality conferences: Their educational role and why we should be there

Safety and Quality as a “Way of Life” in the PICU

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