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Optimizing Morbidity and Mortality Conference for Education and Quality Improvement.

Nina M Clark1, Denzel R Woode2, Lauren L Agoubi3

  • 1Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Seattle, Washington.

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Summary

A new database and scoring system standardized morbidity and mortality conferences (MMC) for acute care surgery. This system facilitates analysis of adverse events and identifies educational opportunities for trainees.

Keywords:
Morbidity and mortality conferenceQuality improvementSurgical education

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Area of Science:

  • Surgical Quality Improvement
  • Medical Education
  • Trauma Surgery

Background:

  • Morbidity and Mortality Conferences (MMC) traditionally lack standardization and have not demonstrated impact on clinical behavior or patient outcomes.
  • A trauma center implemented a dedicated database for acute care surgery MMC events to enhance educational integration and quality improvement initiatives.

Purpose of the Study:

  • To develop and evaluate a standardized reporting platform for adverse surgical events discussed in Morbidity and Mortality Conferences (MMC).
  • To assess the utility of a quantitative scoring system (Quality of Care Score - QCS) in standardizing event reporting and identifying educational gaps.

Main Methods:

  • Surgical trainees utilized a REDCap database to document patient demographics, procedures, and adverse outcomes from May 2020 to November 2022.
  • A Quality of Care Score (QCS) was assigned by trainees pre-conference, with a consensus QCS determined post-conference to standardize event reporting.
  • The study compared trainee-assigned QCS with consensus QCS and analyzed trends in reported adverse events.

Main Results:

  • Data from 679 patients and 916 reported events were analyzed; 65% of patients were admitted for trauma.
  • Exploratory laparotomy (31%) and incision/debridement (15%) were the most frequent procedures. Trainee and consensus QCS scores matched in 84% of cases.
  • Patient deaths constituted 47% of events but decreased proportionally over time. Discordance in QCS scores (12% lower, 3% higher) indicated educational opportunities.

Conclusions:

  • A standardized reporting platform and numeric grading system (QCS) enable rapid, quantitative analysis of surgical adverse events, adaptable to various settings.
  • Discrepancies between trainee and consensus QCS highlight areas for improving education on standards of care and disease processes.
  • Continuous data collection facilitates prompt identification of quality concerns within surgical practice.