Using prospective outcomes data to improve morbidity and mortality conferences.
Background:Though a traditional part of most training programs, surgical morbidity and mortality (M&M) conferences are not optimal for teaching residents how to understand and improve patient outcomes. They tend to focus on unusual rather than common problems and review complications as singular phenomena, rather than recurrent events related to specific processes of care. For these reasons, we began incorporating data from our general surgery outcomes registry into our M&M conference.Developed for both clinical research and quality improvement purposes, the outcomes registry contains prospective information about all patients undergoing general surgery procedures in the operating room (approximately 2000 per year). All adverse events occurring within 30 days of surgery are categorized, using explicit criteria, by clinical nurse coordinators. Individual complications are then collapsed into four severity grades (from a previously validated grading system), from I (not life-threatening, low complexity therapy; eg, superficial wound infection) to IV (death).Application To M&M Conferences:Before each conference the data manager supplies the responsible senior resident with information about caseloads and adverse events for the preceding month. At the conference, individual cases are presented in the context of the department's broader experience with that procedure (eg, rates of wound complications after bowel surgery over the last 2 years). In reviewing trends in complication rates over time, we also explore potential relationships between practice changes and outcomes. When appropriate, local performance is compared to external "benchmarks" using data from published studies.Incorporating prospective outcome data into the M&M conference is both feasible and practical. In addition to its educational value for both resident and attending physicians, we believe this approach creates many opportunities for improving the quality of our surgical practice.
Hamby
LS
Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire, USA
Birkmeyer
JD
Birkmeyer
C
Alksnitis
JA
Ryder
L
Dow
R