Web-based Morbidity and Mortality Conferencing: A Model for Rural Medical Education

Abstract

Transfer of patients from rural emergency departments to tertiary centers can improve outcomes. The transfer process is complex and often ad hoc, inefficient, duplicative, and frustrating to both patients and providers. Suboptimal transfer undermines quality of care, raises costs, and delays services. Unfortunately, the same barriers that make transfer necessary (limited resources, geographic isolation) also hamper effective review. In this article, we describe a Web-based, interactive morbidity and mortality conference series in which providers reviewed cases transferred from rural emergency departments to a tertiary center. Six case-review conferences were conducted over 8 months. Each involved an average of 20 providers representing a total of 7 hospitals. Learning resources (ie, care protocols, best practice reviews, literature reviews) were developed collaboratively and disseminated among participating hospitals following the case-review conferences. Participant responses were highly favorable: 100% found the case reviews "very useful" or "useful" and 100% strongly agreed that the reviews would improve quality of patient care. We conclude that Web-based technology can efficiently facilitate review of transfers and has the potential to positively impact patient care. Future studies should utilize standard validated survey instruments of a larger number of participants to better understand the impact of this intervention.

What Do I Need to Learn Today? — The Evolution of CME

“…Several other studies highlight the importance of CME programs to improve care delivery being designed and led by physicians who understand the complexity and challenges of care delivery. (Van Hoof, 2011;Sargeant, 2006;Eiser, 2013;Pletcher, 2011).…”

Morbidity and mortality meetings: gold, silver or bronze?

“…Appointment of dedicated M&M personnel , for example, departmental M&M coordinators, to take responsibility for the meeting schedule, content and attendance for a defined period Use of appropriate tools and software , including electronic record keeping, case presentation and follow‐up of initiatives, as well as the use of tele‐/video‐/web‐based conferencing to overcome geographical challenges and time restrictions Encouraging self‐reporting of cases/errors , especially anonymously, has been shown to increase the number of safety reports reviewed …”

“…In total, 19 studies identified enablers, 1,3,6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and seven identified barriers, 1,3,19,21,[27][28][29] noting that some studies provided information relevant to both. Characteristics of the included studies are reported in Tables 1 and 2.…”

“…Characteristics of the included studies are reported in Tables 1 and 2. The evidence base was heterogeneous in terms of study design and outcomes, and included descriptive studies, [15][16][17] cross-sectional surveys of staff perceptions about an M&M process, 21,28,29 controlled before-and-after studies of new M&M formats 6,13,[18][19][20]25,26 and one RCT. 22 The methodological quality of the included literature reviews was found to be low 14 to medium.…”

“…Nineteen studies reported factors that enable the effective conduct of M&M meetings. 1,3,6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Across the included studies, the main factors affecting M&M meetings were categorized into three main themes: format, conduct and outcomes.…”