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Standardization of Trauma, General Surgical Morbidity and Mortality Conferences: Development and Dissemination of a
Gabriela Zavala Wong1,2,3, Manuel J Rodriguez Castro4, Eduardo Huaman Egoavil5
1Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru. gabriela.zavala.w@upch.pe.
Background:
Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them.
Methods:
The present study aims to gather general surgeons representing most of Peru's urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices.
Results:
A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described "improve the system" as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p < 0.001).
Conclusion:
We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of "system improvement" as the goal of M&M conferences.
Insights
A standardized Morbidity and Mortality (M&M) conference toolkit was developed and disseminated in Peru. Three years later, surgeons increasingly viewed M&M conferences as a tool for system improvement.
Area of Science:
- Healthcare Quality Improvement
- Surgical Education
- Patient Safety
Background:
- Morbidity and Mortality (M&M) conferences are crucial for reviewing adverse events and identifying clinical practice improvements.
- Structured M&M conferences are underreported in low- and middle-income countries.
- There is a lack of collaborative efforts to standardize M&M conferences globally.
Purpose of the Study:
- To develop a M&M conference toolkit for general surgeons in Peru.
- To assess the impact of the toolkit on clinical practice and quality improvement.
- To standardize M&M conferences across urban surgical care in Peru.
Main Methods:
- A four-component toolkit was developed by 14 general surgeons in collaboration with trauma quality improvement experts.
- The toolkit was disseminated to 10 hospitals in 2016.
- An anonymous written questionnaire survey was used to evaluate practice changes in 2016 and 2019.
Main Results:
- A four-component toolkit addressing logistics, documentation, presentation, and conduct was created.
- Surgeons reported lower attendance in 2019 compared to 2016.
- A significant increase in participants perceiving "improve the system" as the objective of M&M conferences was observed (70.5% in 2019 vs. 38.6% in 2016, p < 0.001).
Conclusions:
- A toolkit for standardized M&M conference dissemination was successfully established in Peru.
- Three years post-dissemination, practice patterns remained largely similar.
- The study demonstrated a significant shift in the perceived purpose of M&M conferences towards system improvement.
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