Redesigning a morbidity and mortality program in a university-affiliated pediatric anesthesia department.
BACKGROUND
The concept of the morbidity and mortality (M&M) review is almost 100 years old, yet no standards describe "good practice" of M&M in clinical departments. Few reports measure output and impact of M&M reviews. The M&M activities were developed in a university-affiliated pediatric anesthesia department as part of a departmental quality improvement (QI) initiative. The process was designed to identify problems within the M&M program and to introduce interventions and actions to increase the program's efficiency and impact.


METHODS
Through a series of interviews and consultation with hospital management, existing problems and inefficiencies were identified, a framework for developing the M&M program was established, and reportable outcome measures, such as increased meeting attendance, participation, self-reporting, and change to practice, were developed. Through appointment of specific M&M personnel, appointment ofa specific departmental M&M coordinator, meeting more regularly, stressing the review of system errors and close calls, and encouraging anonymous reporting, the department's M&M activities were redesigned.


RESULTS
From the (July 1) 2001-(June 30) 2006 to (July 1) 2006-(June 30) 2009 periods, case reviews and case presentations increased from a mean of 1.9 to 3.4 cases presented per M&M meeting. Meeting attendance increased from a mean of 5.1 to 25, and self-reporting from a mean of 22% of all safety reports received to 40%. Findings and recommendations were effectively disseminated throughout the department and hospital, reflecting the unique structure of the M&M program and personnel's efforts.


CONCLUSIONS
M&M QI with respect to data gathering, case review, and ongoing medical education is an efficient way to demonstrate quality assurance and creative professional development.
McDonnell
Conor
C
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto. conor.mcdonnell@sickkids.ca
Laxer
Ronald M
RM
Roy
W Lawrence
WL
D000758:Anesthesia / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D000761:Anesthesia Department, Hospital / Q000458:organization & administration*; D002648:Child; D046688:Child Mortality; D006740:Hospital Administrators; D017052:Hospital Mortality; D006785:Hospitals, University / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D009017:Morbidity; D010372:Pediatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*