title: Introducing a Morbidity and Mortality Conference in Rwanda.
abstract: OBJECTIVE
  To assess the structure, format, and educational features of a morbidity and mortality (M&M) conference in Rwanda. To determine factors associated with adverse events and to define opportunities for improvement.
  
  
  METHODS
  Retrospective, descriptive study of all cases presented at a surgical M&M conference over a 1-year period. Cases were reviewed for factors associated with adverse events and opportunities for improvement. Factors were characterized as delays in presentation, delays in diagnosis, delays in the operating room, errors in judgment, technical errors, advanced disease, and missing resources or malnutrition. Opportunities for improvement were categorized at the physician or hospital level.
  
  
  METHODS
  University Teaching Hospital of Kigali, a tertiary referral hospital in Rwanda.
  
  
  METHODS
  Cases presented at the surgical M&M conference over a 1-year period.
  
  
  RESULTS
  Over a 1-year period, there were a total of 2231 operations with 131 in-hospital mortalities. There were 62 patients discussed at M&M conference. Of those discussed, there were 34 (55%) in-hospital deaths and 32 (52%) unplanned reoperations. Common diagnostic categories included 30 (48%) gastrointestinal, 15 (24%) trauma, and 10 (16%) neoplasm. Delays were commonly cited factors affecting outcomes. There were 22 (35%) delays in presentation, 23 (37%) delays in diagnosis or management, and 20 (32%) delays to the operating room. Errors in judgment occurred in 15 (24%) cases and technical errors occurred in 18 (29%) cases. Twenty-three (37%) patients had a critical resource missing and 17 (27%) patients had advanced disease. Malnutrition was associated with 11 (18%) adverse events. Participants identified opportunities for improvement in 48 (77%) cases.
  
  
  CONCLUSIONS
  M&M conference can be used in a low-resource setting as an educational tool to address core competencies of practice-based learning and improvement and systems-based practice. It can define factors associated with surgical adverse events and opportunities for improvement at the physician and hospital levels.
authors.affiliation: Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Egide
authors.initials: E
authors.lastname: Abahuje
authors.affiliation: Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Innocent
authors.initials: I
authors.lastname: Nzeyimana
authors.affiliation: Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: gehr0059@umn.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Rickard
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D009017:Morbidity; D009026:Mortality; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D012432:Rwanda
keywords: Practice-Based Learning and Improvement; Rwanda; Systems-Based Practice; hospital mortality; hospitals, teaching; morbidity