Optimizing Morbidity and Mortality Conference for Education and Quality Improvement

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.

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.

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.

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.