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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.
Introduction:
Despite their long history, morbidity and mortality conferences (MMC) lack standardization and have not been shown to change behavior or improve outcomes. Our trauma center developed a database to record events discussed at acute care surgery MMC with the aim of improving the integration of MMC for education and quality improvement.
Methods:
From May 2020 to November 2022, surgical trainees documented patient demographics, procedures performed, and details of adverse outcomes in a REDCap database. Using the institutionally developed Quality of Care Score (QCS) to standardize event reporting, trainees scored each event before MMC and consensus QCS was assigned after conference. We describe events presented at MMC and compare trainee to consensus scores.
Results:
We included data from 679 patients who experienced 916 reported events. Sixty-five percent of the cohort was admitted for trauma. Exploratory laparotomy (31%) and incision and soft tissue debridement (15%) were the most common procedures performed. Comparison of trainee versus consensus QCS revealed identical scores in 84% of cases. Consensus scores were lower than trainee scores 12% of the time and higher 3% of the time. While patient deaths comprised the majority of reported events over the study period (47%), they made up a decreasing proportion of overall events reported over time.
Conclusions:
Through the development of a standardized reporting platform for patient events and use of a numeric grading system, our program facilitates rapid quantitative analysis of surgical adverse events using a platform that can be easily adapted to different practice environments and systems. Discordance between trainee and consensus QCS highlights opportunities for trainee education about standards of care and disease processes, and ongoing data collection facilitates rapid identification of quality concerns.
Insights
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.
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.
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