Implementation and Evaluation of a Multidisciplinary Systems-Focused Internal Medicine Morbidity and Mortality Conference

Gonzalo, Jed D.; Bump, Gregory M.; Huang, Grace C.; Herzig, Shoshana J.

doi:10.4300/jgme-d-13-00162.1

Cited by 34 publications

(55 citation statements)

References 27 publications

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“…19,20 Active participation by trainees in M&M conference is recommended, not only in the presentation of cases but also in the development of quality improvement interventions. M&M conference should be 1 component of a comprehensive education program, including topic reviews, case reviews, and procedural training.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Conference for Percutaneous Coronary Intervention

Doll

Overton

Patel

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Morbidity and mortality conference is a common educational and quality improvement activity performed in cardiac catheterization laboratories, but best practices for case selection and for maximizing the effectiveness of peer review have not been determined. Methods and Results-We reviewed the 10-year percutaneous coronary intervention morbidity and mortality conference experience of an academic medical center. Cases were triggered for review by the occurrence of prespecified procedural events. Summary reports from morbidity and mortality conference discussions were linked to clinical data from the Duke Databank for Cardiovascular Disease to compare baseline and procedural characteristics and to assess postdischarge outcomes. Of 11 786 procedures, from 2004 to 2013, 157 (1.3%) were triggered for review. The most frequent triggering events were cardioversion/defibrillation (72, 0.6%), unplanned use of mechanical circulatory support (64, 0.5%), and major dissection (41, 0.3%). Selected procedures were more likely to include high-risk features, such as ST-segmentelevation myocardial infarction, cardiogenic shock, and multivessel disease, and were associated with higher mortality at 30 days. Only a minority of triggering events were caused by controversial or unacceptable physician behavior. Conclusions-This 10-year experience outlines the processes for conduct of an effective percutaneous coronary intervention morbidity and mortality conference, including a novel approach to case selection and structured peer review leading to actionable quality interventions. The prespecified clinical triggers, captured in the natural workflow by laboratory staff, identified complex cases that were associated with poor patient outcomes. (Circ Cardiovasc Qual Outcomes.

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Section: Discussionmentioning

confidence: 99%

Morbidity and Mortality Conference for Percutaneous Coronary Intervention

Doll

Overton

Patel

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…This can encourage a ‘safety culture’ where individuals are able to report errors or close calls without fear of reprimand and there is a general team willingness to address safety concerns and seek solutions 31 32. MMCs offer an opportunity for reflection and learning by close analysis of real-life practical dilemmas in care, stimulating critical thinking and problem-solving skills.…”

Section: Education and Teachingmentioning

confidence: 99%

“…The conferences should be multidisciplinary as modern medical practice is that doctors work in teams and nurses, pharmacists and therapists can often give valuable insight 31. After many years of experience in the University of Pittsburgh Medical Centre, Gonzalo et al 32 established a very successful MMC with a system-focused multidisciplinary approach. This involved the conference chair being allocated one session per week, with administrative support, to facilitate and moderate the discussion and also prepare questions relevant to a multidisciplinary audience.…”

Section: Improving the MMC Processmentioning

confidence: 99%

“…Box 2 summarises the main recommendations derived from the literature review.

Recommendations for medical MMCsMultidisciplinary input and with a senior clinician to select cases, chair and lead discussions2 6 32Encouragement of a ‘safety culture’ with an atmosphere in which individuals feel free to identify and describe known safety threats and errors without fear of ‘blame’31A commitment to create and support safer systems31 32 33Use of a narrative approach to identify omission errors and track transitions of care,16 as well as a trigger tool11Use of themed MMCs—for example, end of life care, sepsis, acute kidney injury34Formal recording of learning points and communication of conclusions—for example, through a safety newsletter6Hospital governance links—for example, reports to Trust Safety Committee/Trust Board5Encouragement and support to the involvement of the junior doctors3MMC, morbidity and mortality conferences.…”

Section: Improving the MMC Processmentioning

confidence: 99%

“…Multidisciplinary input and with a senior clinician to select cases, chair and lead discussions2 6 32…”

Section: Improving the MMC Processmentioning

confidence: 99%

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Medical morbidity and mortality conferences: past, present and future

George

2016

Postgraduate Medical Journal

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Morbidity and mortality conferences (MMCs) have three potential aims-to improve patient safety by reducing adverse events and preventable deaths, to improve overall quality of care as part of the hospital governance structure and as educational learning events. At present, medical MMCs vary widely in format and attendance from hospital to hospital. The evidence for MMCs actually reducing adverse events and preventing avoidable deaths is disappointing. There is better evidence for their educational role. The majority of medical deaths in hospitals are frail older people with poor life expectancy in whom inadequate care is more likely to be due to errors of omission rather than commission. Medical MMCs should be multidisciplinary and led by a senior clinician to encourage discussion and reflection in a 'blame-free' environment. They should be learning events for both clinicians and the organisation as a whole with a structure to support this.

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Defining a High-Quality and Effective Morbidity and Mortality Conference

Beaulieu-Jones,

Wilson,

Howard

et al. 2023

JAMA Surg

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ImportanceMorbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable variability with regard to their completion.ObjectiveTo compile and analyze the literature describing the format, design, and other attributes of MMCs that appear to best advance their stated objectives related to QI and practitioner education.Evidence ReviewFor this systematic review, a literature search with terms combining conference and QI or morbidity and mortality was performed in January 2022, using the PubMed, Embase, and ERIC (Education Resources Information Center) databases with no date restrictions. Included studies were published in English and described surgical or nonsurgical MMCs with explicit reference to quality or system improvement, education, professional development, or patient outcomes; these studies were classified by design as survey based, intervention based, or other methodologies. For survey-based studies, positively and negatively regarded attributes of conference design, format, and completion were extracted. For intervention-based studies, details of the intervention and their impact on stated MMC objectives were abstracted. Principal study findings were summarized for the other group. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Abstract screening, full-text review, and data extraction and analysis were completed between January 2022 and December 2022.FindingsA total of 59 studies met appropriateness for study inclusion. The mean MERSQI score for the included studies was 6.7 (range, 5.0-9.5) of a maximum possible 18, which implied that the studies were of average quality. The evidence suggested that preparation and postconference follow-up regarding QI initiatives are equally as important as both (1) succinctly presenting case details, opportunities for improvement, and educational topics and (2) creating a constructive space for accountability, engagement, and multistakeholder discussion.Conclusions and RelevanceThese findings suggest that the published literature on MMCs provides substantial insight into the optimal format, design, and related attributes of an effective MMC. This systematic review provides a road map for surgical departments to improve MMCs in order to align their format and design with their principal objectives related to practitioner and trainee education, error prevention, and QI.

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Implementation and Evaluation of a Multidisciplinary Systems-Focused Internal Medicine Morbidity and Mortality Conference

Cited by 34 publications

References 27 publications

Morbidity and Mortality Conference for Percutaneous Coronary Intervention

Morbidity and Mortality Conference for Percutaneous Coronary Intervention

Medical morbidity and mortality conferences: past, present and future

Defining a High-Quality and Effective Morbidity and Mortality Conference

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