Thompson J S, Prior M A
Surgical Service Omaha VAMC, Nebraska.
J Surg Res. 1992 Feb;52(2):97-100. doi: 10.1016/0022-4804(92)90285-8.
Many surgeons assert that Morbidity and Mortality (M & M) conference in itself assures an effective quality assurance (QA) program. Recent emphasis on QA in other sectors has resulted in other processes for evaluating quality of care. The goals of QA programs are to identify adverse patient care events, relate these to specific physicians and use this information to improve patient care, and for credentialing and privileging physicians. Our aim was to determine the role of surgical M & M conference in a QA program which also includes occurrence screening, wound infection surveillance, and surgical case review. The weekly M & M conference is a discussion of identified complications and deaths submitted voluntarily by surgeons. During a 2-year period 5755 procedures were associated with 255 complications and 82 deaths. Only 74% of events identified by occurrence screening, 35% of cases identified by surgical case review, and 54% of wound infections had been submitted to M & M conference. Seventy-four percent of surgical residents and 33% of staff surgeons were present at M & M conference when their complications were discussed. Level of care (I, accepted practice; II, may have managed differently; and III, would have managed differently) was assessed for each complication at M & M conference and by peer review of the medical record for occurrence screening.(ABSTRACT TRUNCATED AT 250 WORDS)
许多外科医生断言，发病率与死亡率（M&M）会议本身就能确保一个有效的质量保证（QA）项目。近期其他领域对质量保证的重视催生了评估医疗质量的其他流程。质量保证项目的目标是识别不良患者护理事件，将这些事件与特定医生关联起来，并利用这些信息改善患者护理，同时用于医生资格认证和特权授予。我们的目的是确定外科M&M会议在一个质量保证项目中的作用，该项目还包括事件筛查、伤口感染监测和手术病例审查。每周的M&M会议是对外科医生自愿提交的已识别并发症和死亡病例的讨论。在两年期间，5755例手术出现了255例并发症和82例死亡。事件筛查识别出的事件中只有74%、手术病例审查识别出的病例中35%以及伤口感染病例中54%被提交到了M&M会议。在讨论其并发症时，74%的外科住院医师和33%的在职外科医生出席了M&M会议。在M&M会议上以及通过对事件筛查的病历进行同行评审，对每种并发症的护理水平（I级，公认做法；II级，可能处理方式不同；III级，肯定处理方式不同）进行了评估。（摘要截选于250词）
