Although AE were reviewed in 91% of cases, only 10% offered ‘a structured method’ to address these issues. Excellent staff and innovative teaching methods deliver truly world-class student experiences. study, ‘The ACGME core competency of practice-based learning and improvement was assessed with surgical M&MC.’[ 8 ] Retrospectively analyzing M&M reports prepared predominantly by 5th year general surgery residents, they evaluated the number of AE that occurred vs. those published in the literature. How often are AE discussed in M&MCs involving different subspecialty residency training programs? endobj Epub 2016 Nov 9. Methods:Most studies emphasize the educational role of M&MCs, and differentiate their role from QA. 2012. Data indicate that medical errors, which harm patients, could be limited by instituting various QA measures. x��UMO�@�[������~�-!$H(�j�P\�qp�X"6����&Im’������x���8:o�r�-Z8=���6[��K�Gi�x�/�y4ˊ��ڲ����b2�����O#TB��=$'L�����}�Ba�+ߛ�A���.��F���������� ���dB U`�&��ͣ�uV�&5��\N� ��3_O�F_��� �F�o�A�G��$"ޠ��������ͷ��I��ZWq� b�~�y0k��r��#�$�sJ��]�lEB8��*��rXՍ+��M ݦ. This may represent the fear of embarrassing a colleague or of being viewed as judging the actions of others as previously discussed. The plan was to use ‘unplanned reoperations as a quality indicator.’ Operating room logs and hospital records were retrospectively assessed (January 2008-January 2010). A faculty member who served as the site project director at each residency sent out a standardized e‐mail to all residents in their program describing the study. [ 29 ] To improve the quality of M&MCs, the authors focused on defining and then reporting 20 minor complications (chosen by surgeons) to determine whether this enhanced the ‘educational value’ of the conferences. PROBLEM: The morbidity and mortality (M&M) conference is a vital event that can affect medical education, quality improvement, and peer review in academic departments. In Bal et al. At the end of the conference, the leader reminds the participants of the MM&I's confidentiality once again and evaluates the conference. Conducting a multidisciplinary morbidity and mortality conference in the trauma-surgical intensive care unit. One of the major aims of QA analysis/reporting is to better define, for any discipline, what constitutes an AE. Pierluissi et al., utilizing trained physician observers, prospectively evaluated how frequently AE were discussed during 100 internal medicine case presentations vs. 232 surgical cases. utilized a ‘best practice’ model to assess and develop the optimal postgraduation training program for new nurses. 35: S9-S21, 5. [5]. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. Mortality And Morbidity Conference Dr. Meenakshi Aggarwal PGY2 Emory University Family Medicine * * * * * * * * The first patient with this syndrome was seen in 1986. 2002. 7: 4-, 18. %���� The morbidity and mortality conference: the delicate nature of learning from error. [ 18 ]. Had more programs with less progressive views participated, the important gaps we identified in M&M culture would likely have been greater. endobj [ 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. Rabizadeh S, Gower WA, Payton K, Miller K, Vera K, Serwint JR. Clin Pediatr (Phila). Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. However they may also be associated with errors or omissions in patient care. We found that while EM residents value the conference as an educational session that supports safety culture, the majority of EM residents have not submitted a case to M&M in the past year. Morbidity and Mortality conferences have long been part of the practice of medicine, having originated in the early 1900s with Ernest Codman at Massachusetts General Hospital in Boston. The objectives of a well-run M&M conference are to identify adverse outcomes associated with medical error, to modify behavior and judgment based on previous experiences, and to prevent repetition of errors leading to complications. While site administering faculty were given standardized communications with which to distribute and promote the survey, it is possible that those sites with faculty interested in administering the survey have different styles or culture associated with M&M. The challenges to transparency in reporting medical errors. Furthermore, fewer internal medical vs. surgical cases concentrated on errors leading to AE; 18% for medicine vs. 42% for surgery. JAMA. 2012. Possible explanations include reporting burden, perceived value of reporting, and fear of dissemination. However, the frequency of AE was lower than those reported in other studies [ Table 2 ]. For instance, surgical M&M discussed more cases per conference vs. ICUs or medical units. Both required M&MCs at any university (department with resident-training) hospital. Medicolegal concerns should not be an ‘excuse’ for failing to attend M&MCs, as most universities require 75-100% attendance. They found patients wanted to know what happened, why, how they could be prevented, and expected an apology. Hospital physicians, residents, and staff are encouraged to attend the MM&I. However, the structure, content and format of M&Ms vary widely among institutions. Their use in psychiatric medicine is less evident. Acad Med. Notably, 522 major AE were reported for 461 patients, and they included; mortality (24.1%), hematologic/vascular (16.7%), and gastrointestinal (16.1%). It is possible that more senior residents had longer time horizons (interpreted 12 months as a longer time period). [ 9 ] In 2010, 186 conferences were held at the main campus, while 68 were at satellite sites; and involved a total of 236 Continuing Medical Education (CME) hours. Kravet SJ, Howell E, Wright SM. )’ For example, the Massachusetts Medical Society has a document on line that does require regularly scheduled conferences to maintain the hospital's accreditation. Patrick et al. QA Conferences do not share the same goals as M&MCs. While the vast majority of residents feel that M&M is not punitive, a small minority of residents responded that M&M feels punitive. Can J Surg. Identifying Patterns of Adverse Events of Solid Organ Transplantation Through Departmental Case Reviews. Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. 2001. Best practices in orthopaedic inpatient care. Mezrich JL. By 1983, the ACGME began requiring that accredited residency programs conduct a weekly review of all complications and deaths. QA measures are typically system-wide rather that physician specific. A core team of senior quality consultants prepares the selected cases for presentation, gathering and reviewing information that may have caused the case. Of note, this survey did not specifically ask whether each program called the conference “M&M.” A different naming paradigm could influence resident reporting of events. Educational value of morbidity and mortality (M&M) conferences: are minor complications important?. In the text of the results, responses 1 and 2 are combined to indicate “disagree” and 4 and 5 are combined to indicate “agree.” We calculated a composite culture of safety score by calculating the average of the four AHRQ safety domains.  |  [1] Death, deterioration and complications may be unavoidable in some patients due to underlying disease processes. In the field of pediatric neurosurgery, Drake et al. prospectively assessed how neurosurgical AE (unexpected vs. anticipated complications) due to surgery and/or endovascular procedures were discussed in M&MCs. Focused peer review (FPR) studies, if applicable to different medical disciplines, may have a beneficial impact on physician performance and patient care. The FPR documents were assessed by the chairman, were presented at monthly M&MCs, and resulted in ‘no action to termination.’ This study involved 1646 cases out of 300,000 studies reviewed by 31 radiologists. Clinical Status/ change in status . They provide an invaluable forum for ‘cross talk’ between disciplines, and facilitate the coalescence of cumulative learning and experiences. [ 7 ] First, they acknowledged the increased risks inherent in the total joint, and spinal operations performed in orthopedic patients. Sellier E, David-Tchouda S, Bal G, François P. Morbidity and mortality conferences: their place in quality assessments. Putting the heat back into radiology morbidity and mortality conferences. Int J Health Care Qual Assur. Although the authors accepted the conferences as a teaching tool, they found no clear-cut impact on quality improvement. Residents were less likely to have reported cases to a PSRS than to M&M (difference = 17.8%; 95% CI = 13.9 to 21.9; p < 0.001). With regard to the primary objective of M&M, discussing adverse outcomes had a strong negative association with average AHRQ culture of safety score compared to teaching personal accountability (a decrease in the average AHRQ score of 5.75%, 95% CI = –9.84 to –1.67). However, it is also possible that programs that identify safety culture as an area of deficiency may have perceived a greater need to address the topic. Summary: FPR studies performed for different medical disciplines may have a beneficial impact on physician performance and patient care [ Table 2 ].