Comment évaluer l’impact des revues de morbi-mortalité sur la qualité et la sécurité des soins en réanimation ?

Abstract

ObjectiveTo estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients’ safety. Data sourcesA review of English and French articles in Medline database (1990–2011) related to MMC in the ICU. Keywords used: “morbidity (and) mortality conference(s)”, “intensive care unit”, “intensive/critical care medicine”. Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d’Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. Study selectionOnly original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. Data extractionExtraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. Data synthesisStudies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. ConclusionFurther studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients’ mortality and morbidity.