Abstract
BackgroundThe aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives.MethodsWe conducted an observational study of MMCs and followed up improvement initiatives for 1 year. Data on MMC baseline characteristics were abstracted using document analysis and observation of a meeting in three university hospitals in France (Grenoble, Nice, and Cochin [Paris] hospitals). Fifty-nine MMCs were included in medical (n = 24), surgical (n = 21), and anesthesiology and/or intensive care (n = 14) departments. An effectiveness index was computed by summing a composite score for each initiative pertaining to the MMC.ResultsOverall, 282 initiatives were identified in 42 MMCs. During the follow-up period, 215 initiatives (76 %) were totally or partially implemented and the impact was evaluated for 73 (26 %). An effectiveness index higher than the median (i.e., ≥10) was associated with a standardized presentation of cases (81 % versus 29 %, p <0.001), recording of improvement initiatives (94 versus 57, p = 0.001), the existence of an annual activity report (94 % versus 68 %, p = 0.01), the prior dissemination of a meeting agenda (71 % versus 36 %, p = 0.007), longer meeting duration (109 versus 80 min, p = 0.005), anesthesiology and/or intensive care specialty (39 % versus 7 %, p = 0.02), a theme-focused MMC (29 % versus 4 %, p = 0.01), and a thorough analysis of failures (58 % versus 25 %, p = 0.01).ConclusionsThis study suggests that the implementation of improvement initiatives relates to MCC characteristics. Recommendations for developing more effective patient safety-oriented MMCs can be proposed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1279-8) contains supplementary material, which is available to authorized users.
Highlights
The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives
We examined the associations between the dichotomized effectiveness index and MMC characteristics using the chi-square test or Fischer’s exact test, when appropriate, for categorical variables, the chi-square test for trend for ordered categorical variables, and the Kruskal-Wallis test for continuous variables
The study sample consisted of 59 MMCs, including 24 (40.7 %) in medical units, 21 (35.6 %) in surgical units, and 14 (23.7 %) in anesthesiology or intensive care units
Summary
The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives. Substantial variations exist in MMCs with regard to frequency, attendance, case selection or presentation, analysis methods, and François et al BMC Health Services Research (2016) 16:35 follow-up [13, 14]. This observation may reflect the lack of explicit goals, methods, and format for MMCs [3, 4, 15]. Other studies failed to show any improvement in patient clinical outcomes, [17, 18] probably due to the low incidence of adverse events [18]
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