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A New Era for the Morbidity and Mortality Conference: Aligning Tradition With Systems-Based Quality Improvement Efforts

2016; Lippincott Williams & Wilkins; Volume: 91; Issue: 10 Linguagem: Inglês

10.1097/acm.0000000000001343

1938-808X

Jamie E. Anderson, Diana L. Farmer,

Healthcare Quality and Management

To the Editor: The morbidity and mortality (M&M) conference, a dedicated time for physicians to candidly discuss errors amongst colleagues, has a long tradition in surgery. In recent decades, the discourse around medical errors has shifted from individual responsibility to systems-based efforts. Many surgery departments, including our own, now participate in programs such as the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), University HealthSystem Consortium, and other collaborative initiatives. These programs provide risk-adjusted feedback to individual surgeons and hospitals while also creating multi-institutional databases that allow for an incredible amount of research. However, the swing toward collaborative, systems-based responsibility for patient outcomes has swung so far that some hospitals have abandoned the M&M conference altogether. This is no solution. Instead, we must find ways to merge the case-based M&M conference, focused on individual responsibility, with the systems-based multi-institutional programs. Our department is setting out to merge our M&M process with larger quality improvement efforts. We are beginning with a focused effort to determine root causes of errors. By classifying complications—whether through delay in diagnosis, breakdowns in communication, a technical operating error, etc.—we can begin to understand why our complications occur, which can directly inform improvement efforts. We are also developing a process to track complications and errors. We should be able to identify key areas of improvement, from operating room efficiencies to resident education to communication between or among teams. We should also be able to link data from our M&M discussions with data already collected for other hospital quality improvement initiatives, such as NSQIP. And we are working toward linking all of this information with objective data collected from the electronic medical record, such as vital signs and laboratory values at various points of a patient’s hospitalization. This comprehensive data network will inform quality improvement projects and allow for more nuanced surgical outcomes research. The M&M process is no longer the only way for surgeons to improve patient outcomes, but this does not mean it is losing importance. Nothing beats honest discussion of patient cases that expose our weaknesses and inspire us to be better. In our new era of big data, let us not lose the personal approach to quality improvement through the tradition of the M&M conference. Comprehensive, multi-institutional databases can show us how we are doing—but the M&M process can show us how to do better. Jamie E. Anderson, MD, MPHResident physician, Department of Surgery, University of California Davis Medical Center, Sacramento, California; [email protected] Diana L. Farmer, MDChair and professor, Department of Surgery, University of California Davis Medical Center, Sacramento, California.