OGBN P14 The development, introduction and outcomes of an electronic, patient record-based, Morbidity and Mortality (M&M) reporting system

Abstract

Abstract Background Recording of patient complications and outcomes has suffered from the lack of a standardised reporting system. The aim of this project was to develop and introduce within our health board a generic M&M reporting tool for all surgical and medical specialities which would allow agreed outcomes and actions, following open discussion at M&M meetings, to be documented in the electronic patient record (EPR). Methods TrakCare® (Intersystems) is the electronic patient management system used within our region to record and store information for patient consultations, investigations and treatments. The criteria felt essential were for a reporting system that was suited to all disciplines, accessible to all levels of staff, interlinked between specialities and allowed analysis and reporting of outcomes. Access to all aspects of the EPR including results and imaging should be available during the M&M meeting to facilitate informed discussion. Agreement was reached on the required drop down menus which included patient details, background/event timeline, death certification, end-of-life care, clinical governance, lessons learned and actions and outcomes. ICD-10 codes were used for diagnosis and OPCS-4 coding for procedures. A complication list was developed with word recognition of either the organ system or the complication. Complications were graded according to the Clavien-Dindo classification. All entered data was analysed using Business Intelligence. Results The development process lasted 9 months with the input of the author and programmers from the TrakCare® team. The system was first introduced in September 2017 within the general surgical unit. 1855 patients have been discussed at the general surgical M&M meetings using the system. Since introduction, an additional 37 specialities have adopted the electronic M&M reporting tool. To date 4859 patients in total have been discussed. The introduction of the system has resulted in additional improvements to the M&M process including the requirement for a designated chairperson, a meeting attendance record and documentation of actions and outcomes from meetings. Automatically generated reports show all outstanding actions and recommendations identified at M&M meetings to ensure that the full process is completed. Conclusions The widespread adoption of a standardised M&M reporting tool clearly shows the willingness of care providers to engage in open discussion and learning from M&M meetings. The introduction of a standardised electronic reporting tool has led to additional improvements in the M&M process.