Neurology Morbidity and Mortality Conferences and Quality Improvement: Single-Center Experience and National Survey

Abstract

Background Morbidity and Mortality (M&M) conferences are widespread but vary in goals and methodology. Some focus on clinical enigmas while an increasing number utilize quality improvement (QI) tools to effect systems change. Little is known about the current state of US Neurology M&Ms. Methods We surveyed 56 US academic neurology departments regarding their M&Ms to understand the use of QI tools and assess variability. Additionally, we reviewed the evolution of M&Ms in our department. Results The survey was completed by 44 (80%) departments; 68% reported quarterly frequency with 61% discussing 1–2 safety events per conference. The number of written guidelines or protocols resulting from M&Ms in 2 years varied from 0 (14% of departments), 1–2 (45%), to >5 (5%). Institutional culture regarding quality and safety and conference timing were cited by 71% as important in improving participation. In our own department, the M&M format changed in 2014 based on a sentinel patient event combined with improving safety culture across the hospital: neurology M&Ms transformed into thematic quarterly conferences utilizing QI tools. Attendance increased 3-fold, and in 7 years, we have generated 26 guidelines or pathways with corresponding decision-support tools, among other improvement efforts, resulting in specific systems changes. Based on survey results and our experience, suggested M&M “best practices” include the use of just culture, peer review protection, safety event analysis with QI methodology, trainee involvement, and logistical optimization. Conclusion Structured M&Ms incorporating suggested QI-informed “best practices” can be highly effective in driving system change within neurology.

Reframing the Morbidity and Mortality Conference: The Impact of a Just Culture

“…33 It is important to note that they attribute these successes to their organizational culture, motivation, commitment, communication and inherent skills, rather than the format of the M&M. 33 In line with their findings, another survey-based study attributed success of their M&Ms to the incorporation of a just culture, peer review protection, use of a quality improvement methodology, and logistical optimization. 34 The Ottawa M&M Model contains multiple components but involves training physicians in appropriate case selection and case analysis, interprofessional involvement, an M&M facilitator, and an M&M "bottom line" that is disseminated and later acted on through quality committees. 35 A group of nephrologists used the Ottawa M&M Model and showed that more than half of all conferences held by this group yielded action items and recommendations that led to improved care delivery.…”