[Morbidity/mortality reviews: assessment of their implementation in one hospital].
OBJECTIVE
The objective of this study was to describe the steps involved in establishing a morbidity/mortality review committee (MMRC) to analyze the causes of avoidable deaths or life-threatening complications and the development of plans and protocols to avoid their recurrence.


METHODS
The MMRC included physicians from each hospital department. Each member was responsible for organizing departmental meetings to analyze its avoidable deaths and life-threatening complications.


RESULTS
During its meetings three times a year, the MMRC developed a method for analysis of these serious events. Each department organized 3 (range: 1-12) meetings a year and analyzed 1-3 cases at each. Over 30 months, 35,817 patients were admitted to the hospital and 341 (1%) died. The unexpected mortality rate varied by department and specialty (median: 27%, range: 6-65%). In all, 92 cases were referred to MMRC meetings (27%; range: 6-70% of hospital deaths), and 30% of them involvement nosocomial diseases. Heart disease was the primary cause of unexpected deaths.


CONCLUSIONS
The principal improvements involved medical and surgical strategies, surgical techniques, drug prescriptions, and patient monitoring.
Larrazet
Fabrice
F
Département de Pathologie Cardiaque, Institut Mutualiste Montsouris, Paris. fabrice.larrazet@imm.fr
Meudec
Anne
A
Knani
Lyes
L
El Kadi
Hassen Ben
HB
Bodard
Loïc
L
Caux
Isabelle
I
Cohen
Henri
H
Debrosse
Denis
D
Leblanc
Isabelle
I
Mal
Frédéric
F
Mashour
Babak
B
Prapotnich
Dominique
D
Validire
Pierre
P
Carrat
Valérie
V
D000368:Aged; D000369:Aged, 80 and over; D003226:Congresses as Topic; D004501:Education, Medical; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D009017:Morbidity; D009937:Organizational Objectives