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Identifying Adverse Events in Pediatric Surgery: Comparing Morbidity and Mortality Conference with the
Barrett P Cromeens1, Richard E Lisciandro, Richard J Brilli
1Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH.
Background:
Recent improvements to morbidity and mortality (M&M) conference have focused on the case review system. However, case selection occurs by physician reporting, which is limited by selection bias. We compared the effectiveness of our M&M conference with the NSQIP-Pediatric (NSQIP-P) system for identifying adverse events.
Study Design:
Complications from January 2010 to September 2015 were compared between M&M and NSQIP-P. Only M&M patients meeting NSQIP-P criteria were compared with patients from the NSQIP-P system; exclusions were studied separately. Complication rates in M&M conference before and after a 2012 format change designed to increase case reporting were also compared.
Results:
Detection of mortality in M&M conference and NSQIP-P was not different. Morbidity events identified by NSQIP-P were significantly higher than M&M conference during the entire study period (194 vs 100 occurrences/1,000 cases) (p < 0.0001). Morbidity occurrences in M&M conference increased with the 2012 improvements, however, they still remained less than that identified by NSQIP-P (226 vs 141 occurrences/1,000 cases) (p < 0.0001). Of 863 patients presented in M&M conference, 210 were excluded from direct comparison because they did not meet NSQIP-P criteria. These included 62 deaths and 287 occurrences of morbidity. Their analysis in M&M conference resulted in 32 action initiatives directed at system failures.
Conclusions:
The NSQIP-P identified more complications than M&M. The M&M conference improvements increased reported cases, but they still remained lower than NSQIP-P. However, M&M conference identified events resulting in systems changes that would not have been identified by NSQIP-P. Although NSQIP-P captures occurrences to compare large patient cohorts, M&M analyzes singular failures and initiates direct interventions. Integration of these systems can optimize their usefulness in quality improvement.
Insights
The Pediatric National Surgical Quality Improvement Program (NSQIP-Pediatric) system identified more adverse events than morbidity and mortality (M&M) conferences. However, M&M conferences led to system changes not identified by NSQIP-Pediatric, highlighting the value of integrating both systems for quality improvement.
Area of Science:
- Healthcare Quality Improvement
- Surgical Patient Safety
- Medical Education and Conferences
Background:
- Morbidity and Mortality (M&M) conferences are crucial for healthcare quality improvement, but case selection relies on physician reporting, introducing potential bias.
- Recent enhancements to M&M conferences have focused on case review systems, yet their effectiveness in identifying all adverse events remains a concern.
- The NSQIP-Pediatric (NSQIP-P) system offers a standardized method for tracking surgical complications, providing a benchmark for evaluating M&M conference performance.
Purpose of the Study:
- To compare the effectiveness of traditional M&M conferences with the NSQIP-P system in identifying surgical adverse events.
- To assess the impact of M&M conference format changes implemented in 2012 on the reporting of complications.
- To determine the unique contributions of each system in driving quality improvement initiatives.
Main Methods:
- A retrospective comparison of complications identified by M&M conferences and the NSQIP-P system between January 2010 and September 2015.
- Analysis focused on M&M patients meeting NSQIP-P inclusion criteria, with excluded cases analyzed separately.
- Comparison of complication rates in M&M conferences before and after a 2012 format change aimed at increasing case reporting.
Main Results:
- The NSQIP-P system identified significantly more morbidity events per 1,000 cases compared to M&M conferences (194 vs. 100, p < 0.0001).
- Following a 2012 format change, M&M conference morbidity reporting increased but remained lower than NSQIP-P (226 vs. 141 per 1,000 cases, p < 0.0001).
- M&M conferences identified 32 system-failure-related action initiatives from cases not meeting NSQIP-P criteria, including 62 deaths and 287 morbidity events.
Conclusions:
- While NSQIP-P captures a higher volume of complications for large-scale cohort comparisons, M&M conferences excel at analyzing individual failures and initiating targeted interventions.
- Improvements in M&M conference reporting increased case volume but did not reach NSQIP-P levels.
- Integrating M&M conferences and NSQIP-P can optimize their respective strengths for comprehensive quality improvement in pediatric surgery.
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