Use of Structured Presentation Formatting and NSQIP Guidelines Improves Quality of Surgical Morbidity and Mortality...

Surgical Morbidity and Mortality (M&M) conference lacks a standardized structure across institutions. We compared implementation of structure and National Surgical Quality Improvement Program's (NSQIP) definitions to organize our M&M and identify cases for discussion versus the usually used method at many centers of case identification by an attending surgeon or resident.

A prospective study was performed, over a 10-wk period, to compare the identification of adverse events and the educational value of our M&M conference before and after implementation of structured NSQIP-defined presentations. Chart review was performed by a trained surgical clinical reviewer and trained NSQIP resident of all cases over the study period to identify NSQIP-defined occurrences. All presented M&Ms were evaluated for adequate reporting of adverse events and areas for improvement on a three-point scale. Surveys were administered before and after intervention to assess educational value to resident and faculty on a five-point Likert scale. Survey and presentation data were compared using Student's t-tests. P-values <0.05 were considered significant.

Before intervention, 15% of NSQIP-defined occurrences were identified compared with 81% after intervention (P < 0.01). Thirty-three percent of deaths (1 of 3) before intervention were identified versus 100% (4 of 4) identified after intervention. Surveys obtained from faculty, residents, and students of individual presentations found improved clarity and educational content in cases presented (2.6-2.8) and improved identification of etiology (2.5-2.8), learning points (2.1-2.7), and opportunities for prevention of future adverse events (2.1-2.6) (all P < 0.01). Residents and faculty overall found that the postintervention model better identified adverse events (3.0-3.7, P = 0.02), opportunities for prevention (2.8-3.3, P = . 04), and promoted improved transparency (2.9-3.8, P < 0.01). Eighty-five percent of participants supported the changes in M&M conference.

Incorporation of a clearly defined structure using NSQIP definitions for morbidity and identification of every mortality in our M&M conference standardized identification of adverse events thus improving conference quality. Consideration of the use of this structure should be given to other surgical departmental M&Ms.