A Survey-Based Assessment of the Practices Governing Morbidity and Mortality Conferences and the Effects of the COVID-19 Pandemic

Abstract

Background: Morbidity and mortality (M&M) conferences are essential components for resident education and provide a valuable tool to improve patient safety and quality of care. M&M conferences help identify important gaps in safety and reduce avoidable events in future patient care. Active methods to improve the utilization of M&M conferences have been shown to enhance their educational value for residents, faculty and multidisciplinary teams in healthcare institutions. Objective: The purpose of this study was to use a survey-based methodology to assess how morbidity and mortality conferences are conducted in residency programs, including characteristics such as frequency, involvement of personnel and the effects of COVID-19. Methods: From February to October 2021, a validated 19 question survey was electronically distributed to residency program directors in anesthesiology, emergency medicine and general surgery, after a search for email addresses in the ACGME database. The survey was created and hosted on Google Forms. Results: A total of 125 of 713 program directors (17.5%) responded to the survey. Eighty-three percent of respondent programs reported mandatory participation for residents, with residents providing most of the presentations. Case presentations utilized various formats including SBAR, adverse event analysis and root cause analysis as the most common modalities. Though most programs reported no change in frequency of M&M conferences due to COVID-19, most respondents reported a shift to a virtual or hybrid platform. Conclusion: M&M conferences are an important educational and quality improvement modality, and many residency directors changed practice to incorporate virtual platforms due to the COVID-19 pandemic to maintain uninterrupted educational sessions. Nonetheless, significant variation still exists in how these conferences are conducted between different institutions.

A Near-Miss in Clinical Outcomes Research Data Collection

“…Concerns about the integrity of clinical research data have led some authors to advocate strategies for avoiding errors, including process standardization, electronic data capture, safe work environments, and the introduction of redundancies [15][16][17] . The use of an M&M format may be a model that is applicable to the research domain as well 12 . Learning from reported errors may lead to strategies to reduce risks, improve early detection, and mitigate the effects of future research errors.…”

“…The practice of reporting and learning from one’s errors was refined by Ernest Amory Codman, a surgeon at Massachusetts General Hospital in the early twentieth century, through his “end result system.” 8 His model influenced the 1916 standards for hospital practice that were issued by the American College of Surgeons. This framework has evolved into modern M&M conferences that often follow preset formats, including the Situation-Background-Assessment-Recommendation (SBAR) format, root cause analysis, adverse event analysis, and the Ottawa M&M model, resulting in audience engagement, educational value, and improvements in patient safety through a collegial, nonadversarial systematic review of errors 9-12 . Since 1983, M&M conferences have been a requirement of the Accreditation Council for Graduate Medical Education (ACGME) for the certification of training programs.…”