Quality Improvement Focused Morbidity and Mortality Rounds: An Integrative Review.

Kayla P Churchill,Justin Murphy,Nick Smith

doi:10.7759/cureus.12146

Kayla P Churchill, Justin Murphy + Show 1 more

Open Access

https://doi.org/10.7759/cureus.12146

Copy DOI

Journal: Cureus	Publication Date: Dec 18, 2020
Citations: 10	License type: cc-by

Affiliation: Eastern Health, Memorial University of Newfoundland

Abstract

Morbidity and mortality conference (MMC) is a century-old tradition in medicine that was initially primarily focused on the review of surgical outcomes and errors. In recent years, the value of MMC in quality improvement (QI) and patient safety initiatives has been realized and incorporated into the MMCs of some disciplines and institutions. Despite this, there is a need for a standardized structure of MMC that emphasizes both QI and patient safety.The purpose of this integrative review is to synthesize the literature on MMC structure that is reflective of QI and patient safety.An integrative literature search was carried out using PubMed and MEDLINE. s were reviewed and non-relevant articles were excluded. Exclusion criteria were no mention of MMC, analysis of specific case, no focus on QI or patient safety, and non-English language.A total of 21 articles were identified for review. Articles were reviewed in their entirety for content regarding structuring of the MMC to reflect and further develop QI and patient safety. The follwing three themes emerged that were consistently identified as being important for restructuring MMCs: (1) the importance of careful case selection, (2) the format of discussion during the conferences, and (3) the action plans reflecting QI initiatives derived from the conferences.The review suggests that one standardized method of MMC implementation that encompasses the three pivotal themes should be developed. Further research needs to focus on instituting measures of effectiveness for the new MMC model.

Highlights

BackgroundMorbidity and mortality rounds or conferences originated in the early 1900s and were developed initially by the surgical disciplines to review surgical errors
The morbidity and mortality conference (MMC) is a method of incident analysis that has been present in medicine for over a century
Given the new focus on patient safety and quality improvement (QI), the proposal is a shift from analysis of incidents that may or may not be preventable to those that have system-wide implications of failure, even in the face of no actual harm to the patient

Summary

Introduction

Morbidity and mortality rounds or conferences originated in the early 1900s and were developed initially by the surgical disciplines to review surgical errors. The second is that the generation of issues is a product of the MMC discussion itself, stressing the importance of involving other disciplines and healthcare professionals in an effort to identify all of the system failures demonstrated by the case [9,16,17] The former allows for greater evaluation of the presenter’s understanding of the case with relation to QI and patient safety, and as the presenter is usually a medical resident, this allows for educational evaluation by attending physicians [11]. The conference itself would likely be more time-intensive with the extensive discussion and root cause analysis required in each session With this proposed model of MMC, the work would not cease at the end of the session, but certain participants would be tasked with implementing and following up on action plans. It may be reasonable to consider implementation of this model for MMC in other healthcare settings across the world to investigate whether this model is transferable, and this could lead to international standardization of MMC

Conclusions

Findings

Disclosures