Improving Quality of Care and Patient Safety Through Morbidity and Mortality Conferences

Abstract

The objective was to evaluate the analysis of adverse events and the decisions for quality improvement decided during morbidity and mortality conferences (MMCs). We conducted a prospective observational study of MMCs conducted in a teaching hospital between November 2007 and May 2008. Two observers attended the conferences and collected data on the structure of MMCs, the discussion between attendees, and the decisions or actions for quality improvement. Twenty-four MMCs were studied including 146 cases. A majority of the senior physicians present (87.7%) took part in debating the cases; the participation of residents was lower (32.6%) and varied between departments (p < .001). Few paramedical professionals and other attendees participated in the debate. Shortcomings were sought in 91% of cases, but a structured method was used in less than 10% of cases. An analysis of underlying factors contributing to these shortcomings was observed in 75% of cases, with 4% considered structured and thorough. Eighty-five decisions or actions to improve quality of care or patient safety were listed, with 28 of them (33%) planned for implementation. Discussion of adverse events appears to lack a structured method and although a large number of decisions for quality improvement were declared, fewer actions were planned with a timeline.

Implementation of a structured hospital-wide morbidity and mortality rounds model

“…Aboumatar et al 20 described a prospective observational study on current practice at John Hopkin's Hospital that included 12 clinical divisions. Similarly, Bal et al 21 and Sellier et al 30 reported on a census of 13 clinical centres, 41 clinical departments and 140 wards at the Grenoble University Hospital in France, where they collected observational data on 24 of the 27 different departments that held M&M rounds. Of the innovative models piloted on a “hospital-wide” level, Higginson et al 45 provided the largest experience to date with only five clinical groups across two hospital divisions; Schwarz et al 46 also described a hospital-wide study, which involved a 28-staff rural hospital in Nepal.…”

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

“…series, 2 observers prospectively attended 24 M&MCs involving 146 cases over a 6-month period (2007 to 2008). [1] They focused on the structure, discussions, decisions, and actions of these conferences, along with their impact on quality improvement. Participation primarily involved senior physicians (87.7% of those present), and to a lesser degree residents (32.6% of those present), but rarely ‘paramedical professionals and other attendees.’ Notably, these percentages varied for different departments.…”

Medical morbidity and mortality conferences: past, present and future

“…From this, 33 action items were decided and acted on, including introduction of the SBAR (situation, background, assessment, recommendation) tool to improve communication 20. Similarly, a study in France looked at medical MMCs in a French teaching hospital 21. Two observers attended 24 conferences, which included 146 cases.…”