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To assess the value and outcomes of contemporary, voluntary meetings reviewing the morbidity and mortality among surgical patients presenting at a New Zealand metropolitan hospital.
Data on morbidity and mortality were prospectively collected and analysed over a two year period (March 2005-August 2007) from weekly departmental meetings. Patients we...
Citations
... Las M&M deben ser concebidas como un escenario integrador al evaluar y gestionar una política de mejoramiento de la calidad hospitalaria mediante un análisis de eventos adversos, generando así, explícitamente, educación médica en todos los niveles (pregrado, posgrado y profesionales en ejercicio), incluso en las IPS con un perfil no académico dentro de su misión y visión institucionales (14) . Su ejecución constituye un modelo de aprendizaje que analiza metódicamente los factores que conducen al desenlace negativo y establece una valoración objetiva de la seguridad de la atención del paciente en la institución (15)(16)(17) . ...
"Si al final todo resulta bien, entonces lo que se diga en mi contra no importará. Si me equivoco, diez ángeles jurando que tenía razón no harán la diferencia." Abraham Lincoln. RESUMEN Las reuniones o conferencias de morbilidad y mortalidad (M&M), una práctica común en todo el mundo, buscan evaluar los eventos adversos y las complicaciones relacionadas con la atención médica, desde una perspectiva académica y considerando un mejoramiento en la calidad de la atención hospitalaria. Sin embargo, en nuestro país, su ejecución es un desafío metodológico debido a la dificultad para su conceptualización, implementación, evaluación de su efectividad y utilidad como herramienta educativa; al estar carente de una estructura formalizada que considere estos temas. El objetivo de este trabajo es evaluar su papel desde una perspectiva académica individual e institucional, considerando diferentes teorías y modelos que podrían apoyar el M&M (teoría del aprendizaje experimental, teoría de la actividad en el aprendizaje sociocultural, cultura justa, teoría de la seguridad del modelo y teoría de la segunda víctima), con el fin de responder la pregunta: ¿son las reuniones de M&M una estrategia de aprendizaje? PALABRAS CLAVE Aprendizaje; Educación Médica; Métodos; Morbilidad; Mortalidad IATREIA Vol 33(3) 286-297 julio-septiembre 2020 ARTÍCULO DE REFLEXIÓN
... Clinicians have questioned the accuracy and completeness of such data. 2 In moving towards increased public transparency of clinical outcomes and meeting the increasing public and media requests for individual surgeon outcomes, 3 the accurate coding, interpretation and presentation of audit data have become paramount. ...
... Even something as seemingly dichotomous as mortality, has been shown to be incorrectly coded at this centre. 2 Here, the quality of the data should be assured as clinicians enter it prospectively alongside their day-to-day activities. ...
Background:
In measuring quality of health-care delivery, digital infrastructure is essential. The aim at this tertiary centre was to create a hospital-wide workflow system that collected data prospectively as part of daily practice.
Methods:
In moving towards an electronic health record, a hospital-wide integrated workflow system was introduced in 2013, which electronically managed the perioperative patient journey while simultaneously facilitating surgical audit. Analysis of its implementation was carried out presenting early outcomes using general surgery as an example.
Results:
Theatre-bookings (44 953) were made with compliance approaching 90% for all services. Of 7179 general surgical operations over 24 months, 5785 (80%) had an operation note created using the new system. Cumulative summation of uptake of synoptic operative reporting (SOR) for laparoscopic cholecystectomy (LC) was 81% with documentation being superior in terms of antibiotic use and steps to safe cholecystectomy (P < 0.001). A LC SOR took 4 min to complete (interquartile ranges 2-5 min, n = 425) and was immediately available on the day of surgery compared to narrative operative reports taking 2 days (interquartile ranges 1-5 days, n = 174) (P < 0.001). From July 2014 to November 2015, 557 (10%) complications were recorded for 5749 general surgical operations with 99% of complications being reviewed.
Conclusion:
The rapid and sustained uptake of both theatre-bookings and SOR likely reflect high end-user satisfaction with the system. Service metrics indicate a significant improvement in the time of delivery. The ability to seamlessly complete the audit cycle at an individual, department and hospital level has been achieved.
... A widely held general opinion amongst trainees and a significant proportion of consultants is that these meetings are meant to label blame and settle scores, with learning issues being an incidental outcome. 1 shows that a significantly high proportion of occurring morbidities are not presented in departmental morbidity reviews; up to 70% in certain studies. 2,3 Our review showed that slightly over 50% of recorded morbidities made their way to the official morbidity record. Closer analysis did reveal interesting aspects of the situation. ...
To review the utility of morbidity and mortality forum in General Surgery at a tertiary care hospital in Karachi, Pakistan.
The retrospective study was conducted at the Aga Khan University Hospital and reviewed morbidity data from March to May 2009. Case notes of all patients admitted to the General Surgical service during the study period were reviewed to identify in-hospital morbidities.
There were a total of 340 inpatients during this period. Case notes identified 61 (17.94%) patients with morbidities; 35 (57.37%) males and 26 (42.62%) females. The morbidity record for the same period identified 32 (52.5%) patients, while 29 (47.5%) morbidities were missed. Of the total morbidities, 32 (52.5%) patients were admitted to the general ward, and 29 (47.5%) to high dependency areas. Nine (28%) morbidities identified in the general ward, and 23 (79%) in high dependency areas were formally presented. Morbidities related to the abdominal cavity were the commonest (n = 22; 36%). Wound-related (n = 17; 28%) and cardio-pulmonary (n = 8; 13%) complication were the next most frequent.
Abdominal cavity morbidities were the most common in this review followed by wound related and cardiopulmonary complications. The morbidity and mortality forum is an educational activity that has stood the test of time and continues to be the cornerstone of post-graduate education. It should be considered a mandatory activity in all postgraduate training programmes.
Importance There is a paucity of literature on the quality and effectiveness of institutional morbidity & mortality (M&M) rounds processes.
Objective We sought to implement and evaluate the effectiveness of a hospital-wide structured M&M rounds model at improving the quality of M&M rounds across multiple specialties.
Design, setting, participants We conducted a prospective interventional study involving 24 clinical groups (1584 physicians) at a tertiary care teaching hospital from January 2013 to June 2015.
Intervention We implemented the published Ottowa M&M Model (OM3): appropriate case selection, cognitive/system issues analyses, interprofessional participation, dissemination of lessons and effector mechanisms.
Main outcomes and measures We created an OM3 scoring index reflecting these elements to measure the quality of M&M rounds. Secondary outcomes include explicit discussions of cognitive/system issues and resultant action items.
Results OM3 scores for all participating groups improved significantly from a median of 12.0/24 (95% CI 10 to 14) to 20.0/24 (95% CI 18 to 21). An increased frequency of in-rounds discussion around cognitive biases (pre 154/417 (37%), post 256/466 (55%); p<0.05) and system issues (pre 175/417 (42%), post 259/466 (62%); p<0.05) were reported by participants via online surveys postintervention, while in-person surveys throughout the intervention period demonstrated even higher frequencies (cognitive biases 1222/1437 (85%); system issues 1250/1437 (87%)). We found 45 action items resulting directly from M&M rounds postintervention, compared with none preintervention.
Conclusions and relevance Implementation of a structured model enhanced the quality of M&M rounds with demonstrable policy improvements hospital wide. The OM3 can be feasibly implemented at other hospitals to effectively improve quality of M&M rounds across different specialties.
Value of the morbidity and mortality conferences
Many physicians were trained when morbidity and mortality (M & M) conferences, although often harrowing experiences, were also the educational highlights of our residencies. We not only learned that we were answerable for our morbidity/adverse events (AEs) and mortality of our patients, but also learned that our mentors had the same inherent accountability, concerns, and responsibilities. In short, we all had to acknowledge, learn, and teach from our shortcomings to avoid repeating them.
Background:
Routine data not only allow for the mapping of a department in terms of quality-relevant aspects, but also for a comparison with other hospitals in the context of hospital associations. Currently available system options are demonstrated using the example of a department for general and visceral surgery.
Material and methods:
Quality indicators and their algorithms have been developed by the CLINOTEL office in consultation with specialist disciplines. The base population as well as the specific criterion that stands for the unwanted event to be investigated is defined for all individual quality indicators by way of in- and exclusion criteria. In addition, case reports are transmitted; these are lists of relevant case data, which are prepared as soon as at least one quality indicator has been identified from the analysis of the case data (screening function).
Results:
A total of 16 case reports were generated for 251 cases of hernia, which corresponds to 6.4%. There were 21 case reports for 58 colon resections (36.2%). 5 cases of hernia and 11 cases from the group of colon resections were presented in M&M conferences, in the course of which measures to prevent unwanted events during colon and hernia surgery were developed. A part of these measures was also the introduction of a "for immediate medical attention" checklist, containing a list of clinical symptoms that in our view require the immediate attention of a doctor. Previously, our M&M conference had no defined "script" that would include questions in need of urgent attention and therefore of urgent answers. However, the complexity of individual cases has shown that the conferences must acquire a more formalised format.
Conclusion:
QSR constitutes an important information channel with a positive cost-benefit ratio for department managers of surgical clinics. The information gained can be used for clinical quality monitoring and also for the screening of conspicuous courses of treatment. Taking into account the intrinsic limitations of classification systems for diagnoses and procedures, and a systematic monitoring of documentation and coding quality, this should result in a continuous improvement process in terms of surgical care.
Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.
The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.
Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.
Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.
It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.
