A Morbidity and Mortality Conference-Based Classification System for Adverse Events: Surgical Outcome Analysis: Part I

Practice-Based Learning and Improvement: A Two-Year Experience with the Reporting of Morbidity and Mortality Cases by General Surgery Residents

“…Our adverse event rate reported by general surgery residents at the University of Pittsburgh Medical Center (2.5%) was even lower than the existing adverse incident underreporting rate by residents in the largest study we could find in the published literature (4.3%). 8,9 Our institutional reporting rate falls far below the more objective adverse event rates for patients of 29% to 41%. [5][6][7] The causes behind this degree of underreporting are unclear.…”

“…A proportion test was performed to compare the incidence of adverse events in the University of Pittsburgh Medical Center with the 1268 patients with adverse events over 29,237 total cases (4.3%) found in the published literature. 8 All cases listed by the senior residents were evaluated over the study period. Cases appearing in duplicate and "interesting cases" without adverse events were omitted from the analyses.…”

“…Cases appearing in duplicate and "interesting cases" without adverse events were omitted from the analyses. Deidentified patient cases were described according to the 15 adverse event categories and modified subcategory listings described by Antonacci et al 8,9 Adverse events categorized as deaths by this method were subsequently categorized by a modified method as described by Nugent. 10 In the original method, (5) Pre-Existing Catastrophic Conditions.…”

“…Second, we want to determine the adverse event rate for patients reported across surgical services and compare this rate to the largest published resident-based reporting rate found in the literature of 4.3%. 8,9 Finally, we want to describe the nature of those adverse events to start to understand which complications general surgery residents deem important or relevant to report at surgical Morbidity and Mortality Conference. We hypothesize that the reporting patterns and incidence rates for patient adverse events will remain constant over time, and that our institutional adverse event rate will be comparable with the largest resident-based reporting adverse event rate of 4.3%.…”

Educational Value of Morbidity and Mortality (M&M) Conferences: Are Minor Complications Important?

“…2 Residency programs have attempted various ways to improve the educational value of M&M conference and increase the rate of complications reported, such as incorporating a systems audit that increased residents' awareness of systems based issues and implementing a mandatory review by a department quality improvement committee of all M&M reports submitted. 3,4 Traditionally, the M&M conference focuses on the mortalities or complications that caused a significant change in a patient's postoperative course, such as pulmonary embolus or anastomotic leak, although these are clearly underreported. A national survey of 34 surgery departments associated with medical schools found that only 76% of institutions report all deaths and 50% report all complications, 5 thus limiting the impact on education.…”