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.
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto. conor.mcdonnell@sickkids.ca
Conor
C
McDonnell
Ronald M
RM
Laxer
W Lawrence
WL
Roy
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*