From the Department of Surgery, University of British Columbia, Vancouver, BC (Slater, Sekhon, Shariff, Chiu, Joos, Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bradley); Quality and Patient Safety, Vancouver Coastal Health, Vancouver, BC (Bedford); Trauma Services, Kelowna General Hospital, Kelowna, BC (Wong); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball).
Can J Surg. 2020 May 8;63(3):E211-E222. doi: 10.1503/cjs.009219.
In medical and surgical departments around the world, morbidity and mortality conferences (MMC) serve dual roles: they are cornerstones of quality-improvement programs and provide timely opportunities for education within the urgent context of clinical care. Despite the widespread adoption of MMCs, adverse events and preventable errors remain high or incompletely characterized, and opportunities to learn from and adjust to these events are frequently lost. This review examines the published literature on strategies to improve surgical MMCs.
We searched OVID Medline, PubMed, Embase and CENTRAL. We defined our combination of search terms using a PICO (population, intervention, comparison, outcome) model, focusing on the use of MMCs in general surgery.
The MMC literature focused on 5 themes: educational value, error analysis, case selection and representation, attendance and dissemination. Strategies used to increase educational value included limiting case presentation time to 15-20 minutes, mandatory brief literature reviews, increasing audience interaction, and standardizing presentations using a PowerPoint template or SBAR (situation, background, assessment, recommendation) format. Interventions to improve error analysis included focused discussion on causative factors and taxonomic error analysis. Case selection was improved by using an electronic clinical registry, such as the National Surgery Quality Improvement Program, to better capture incidence of morbidity and mortality. Attendance was improved with teleconferencing. Dissemination strategies included MMC newsletters, incorporating MMCs into plan-do-check-act cycles, and surgeon report cards.
Greater standardization of best practices may increase the quality improvement and educational impact of MMCs and provide a baseline to measure the effect of new MMC format innovations on the clinical and educational performance of surgical systems.
在全球的医学和外科部门，发病率和死亡率会议（MMC）发挥着双重作用：它们是质量改进计划的基石，并在临床护理的紧急情况下为教育提供及时的机会。尽管 MMC 已被广泛采用，但不良事件和可预防的错误仍然居高不下或未得到充分描述，并且从这些事件中学习和调整的机会经常丧失。本综述考察了已发表的关于改进外科 MMC 的文献。
我们在 OVID Medline、PubMed、Embase 和 CENTRAL 上进行了搜索。我们使用 PICO（人群、干预、比较、结局）模型定义了我们的搜索词组合，重点关注一般外科中 MMC 的使用。
MMC 文献集中在 5 个主题上：教育价值、错误分析、病例选择和代表性、出席情况和传播。为提高教育价值而采用的策略包括将病例报告时间限制在 15-20 分钟内、强制性的简短文献复习、增加观众互动，以及使用 PowerPoint 模板或 SBAR（情况、背景、评估、建议）格式标准化报告。为改进错误分析而采取的干预措施包括集中讨论致病因素和分类错误分析。通过使用电子临床登记系统（如全国手术质量改进计划）更好地捕获发病率和死亡率，病例选择得到了改善。通过电话会议提高了出勤率。传播策略包括 MMC 通讯、将 MMC 纳入计划-执行-检查-行动循环以及外科医生报告卡。
更大程度的标准化最佳实践可能会提高 MMC 的质量改进和教育影响力，并为衡量新的 MMC 格式创新对手术系统的临床和教育绩效的影响提供基准。
