Transforming surgical morbidity and mortality into a systematic case review

Area of Science:

• Healthcare Informatics
• Surgical Quality Improvement
• Pediatric Surgery

Background:

• Traditional surgical morbidity and mortality (M&M) conferences provided peer review and trainee education but lacked data for analysis.
• Limited data capture and trending hindered performance improvement initiatives.
• An institution-wide effort aimed to create an electronic system for better event capture and feedback.

Purpose of the Study:

• To implement a structured, electronic case review system for surgical M&M.
• To improve the capture of surgical complications and provide real-time performance feedback.
• To facilitate surgical performance improvement through data analysis and trending.

Main Methods:

• Developed a secure online database with a 3-step classification: Clavien-Dindo severity, peer review, and fishbone analysis.
• Implemented an interactive dashboard for data visualization and analysis.
• Conducted a retrospective tabulation of 2018 M&M data using the previous paper system for comparison.

Main Results:

• In 2019, 193 complications were captured, increasing the capture rate to 50 per 1000 procedures (vs. 35 in 2018).
• The dashboard provided run charts for complication incidence and types by procedure and surgeon.
• Enabled creation of surgeon performance reports and directed process improvement projects and educational content.

Conclusions:

• The electronic database and dashboard transformed surgical M&M into a systematic review process.
• The system significantly improved event capture and provided novel feedback for quality improvement.
• Electronic reporting tools facilitate data-driven process improvements and educational initiatives across surgical divisions.