Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru.
Postdoc, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, USA.
World J Surg. 2023 Jan;47(1):61-71. doi: 10.1007/s00268-022-06752-1. Epub 2022 Oct 10.
Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them.
The present study aims to gather general surgeons representing most of Peru's urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices.
A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described "improve the system" as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p < 0.001).
We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of "system improvement" as the goal of M&M conferences.
发病率和死亡率（M&M）会议使临床医生能够审查不良事件并确定改进领域。在中低收入国家，很少有关于结构化 M&M 会议的报告，也没有关于协作标准化这些会议的报告。
本研究旨在汇集秘鲁大部分城市外科护理的普通外科医生，并与创伤质量改进专家合作，开发一个 M&M 会议工具包，希望其传播能够影响他们报告的临床实践。14 名普通外科医生作为秘鲁普通外科学会下属工作组的一部分开发了一个工具包。三年后，我们进行了一项匿名书面问卷调查，以跟踪之前对质量改进实践的观察。
开发了一个由四个组件组成的工具包：工具包组件#1：会议后勤和病例选择；工具包组件#2：记录表格；工具包组件#3：演示模板；和工具包组件#4：行为准则。该工具包于 2016 年分发给 10 家医院。通过比较 2016 年（101 名受访者）和 2019 年（105 名受访者）在工具包传播前和传播后进行的质量改进实践调查结果来评估其效果。2019 年报告的外科医生出席率较低。然而，在 2019 年，参与者更频繁地将“改善系统”描述为 M&M 会议的预期目标（70.5%比 2016 年的 38.6%；p<0.001）。
我们为全国推广标准化的 M&M 会议制定了一个工具包。在秘鲁进行初始评估三年后，我们发现除了更多地报告“系统改进”作为 M&M 会议的目标外，实践模式相似。
