Toward Best Practices for Surgical Morbidity and Mortality Conferences: A Mixed Methods Study

Publication date: Available online 15 July 2017
Source:Journal of Surgical Education
Author(s): Marit S. de Vos, Perla J. Marang-van de Mheen, Ann D. Smith, Danny Mou, Edward E. Whang, Jaap F. Hamming
ObjectiveTo assess formats for surgical morbidity and mortality conferences (M&M) for strengths and challenges.DesignA mixed methods approach with local observations to assess key domains of M&M practice (i.e., goals, structure, and process/content) and surveys to assess participants' expectations and experiences.SettingSurgical departments of two teaching hospitals (Boston, USA and Leiden, Netherlands).ParticipantsParticipants of surgical M&M, including attending surgeons, residents, physician assistants, and medical students (total n = 135).ResultsSurgical M&M practices at both hospitals had education as its overarching goal, but varied in structure and process/content. Expectations were similar at both sites with ≥80% of participants (n = 90; 67% response) expecting M&M to be focused on education as well as quality improvement (QI), blame-free, mandatory for both residents and attendings, and to lead to changes in clinical practice. However, compared to expectations, significantly fewer participants at both sites experienced: a QI focus (both p < 0.001); mandatory faculty attendance (p = 0.004; p < 0.001) and changes to practice (both p < 0.001). In comparison, at the site where an active moderator and QI committee are present, respondents seemed more positive about experiencing a QI focus (73% vs 30%) and changes to practice (44% vs 16%).ConclusionDespite variation in M&M practice, the same (unmet) expectations existed at both hospitals, indicating that certain challenges may be more universal. M&M was reported to be well-focused on education, and certain aspects (e.g., active moderator and QI committee) seemed beneficial, but expectations were not met for the conference's focus and function for QI. Greater exchange of "best practices" for M&M may enhance the conference's value for improving surgical care.



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