title: Morbidity and Mortality conference as part of PDCA cycle to decrease anastomotic failure in colorectal surgery.
abstract: OBJECTIVE
  Morbidity and Mortality meetings are an accepted tool for quality management in many hospitals. However, it is not proven whether these meetings increase quality. It was the aim of this study to investigate whether Morbidity and Mortality meetings as part of a PDCA cycle (Plan, Do, Check, Act) can improve the rate of anastomotic failure in colorectal surgery.
  
  
  METHODS
  From January 1, 2004, to December 31, 2009, data for all anastomotic failures in patients operated on for colorectal diseases in the Department of Surgery (Klinikum Friedrichshafen, Germany) were prospectively collected. The events were discussed in Morbidity and Mortality meetings. On the basis of these discussions, a strategy to prevent anastomotic leaks and a new target were defined (i.e. 'Plan'). This strategy was implemented in the following period (i.e. 'Do') and results were prospectively analysed. A new strategy was established when the results differed from the target, and a new standard was defined when the target was achieved (i.e. 'Check, Act').
  
  
  RESULTS
  The year 2004 was set as the base year. In 2005 and 2006, new strategies were established. Comparing this period with the period of strategy conversion (2007-2009), we found a significant decrease in the anastomotic failure rate in colorectal surgery patients (5.7% vs 2.8%; p = 0.05), whereas the risk factors for anastomotic failure were unchanged or unfavourable.
  
  
  CONCLUSIONS
  If Morbidity and Mortality meetings are integrated in a PDCA cycle, they can decrease anastomotic failure rates and improve quality of care in colorectal surgery. Therefore, the management tool 'PDCA cycle' should be considered also for medical issues.
authors.affiliation: Abteilung für Allgemein-Viszeral- und Thoraxchirurgie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223 Celle, Germany. peter.vogel@akh-celle.de
authors.forename: Peter
authors.initials: P
authors.lastname: Vogel
authors.forename: Georgi
authors.initials: G
authors.lastname: Vassilev
authors.forename: Bernd
authors.initials: B
authors.lastname: Kruse
authors.forename: Yesim
authors.initials: Y
authors.lastname: Cankaya
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D057868:Anastomotic Leak / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003226:Congresses as Topic / Q000458:organization & administration*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis