L., Scott,., nelson,., cox,. Educational quality improvement report: outcomes from a revised morbidity and mortality format that emphasised patient safety. Quality and Safety in health Care, 16(6 422-427 Conclusion From the evidence identified, there is no peer reviewed evaluation of the best-practice guidelines of mmrs. Furthermore, there is very limited peer-reviewed literature exploring patient-centered outcomes as a result of the mmr process. It has been reported that in surgical departments, mandatory mmrs result in a 40 decrease in gross mortality over 4 years. There is evidence that indicates that mmrs are effective in identifying and engaging clinicians in system improvements, reducing deaths, and creating safe discussion forums. In saying this however, there is a vast body of grey literature available that has been developed by a range of national and international healthcare partners.
Research, methodology, literature, review, qualitative
Governance integration and Follow up There is a mixture of evidence for positions responsible for follow-up within an organisation. Generally, leadership/management should be involved in the findings of all mmrs 2, 24,. Additionally, risk/Quality teams should also be involved in the process as findings may be a result of issues with system processes 1, 2,. Improvement measures determined by the mmrs should also be communicated down to the frontline staff through ward-based specialty governance and clinical management positions/staff. Leadership/management may also have a responsibility to further report the findings and recommendations to an appropriate health or regulatory authority. A previous review has identified that: "Follow up tends to be limited to either case summary reports and or designating individual to follow up actions. Some studies have reported more comprehensive approaches including documentation of outcomes, evaluations, development of action plans, verbal updates at subsequent mmrs, written reports and tracking of actions" 20 Examples of tools used to facilitate morbidity and Mortality reviews a vast variety of tools used. Below is a list of some selected examples. Safe anaesthesia liaison Group - gujarati anaesthesia morbidity and Mortality meetings: a practical toolkit for Improvement Emergency care Institute new south Wales - ed quality Framework flying death Audit szostek,. A systems approach to morbidity and mortality conference. The American journal of medicine, 123(7 663-668 Bechtold,.
What are the key lessons for the organisation? Tips: Important items for m m: Mandatory resident and Faculty attendance decreasing defensiveness and blame Improving the efficacy of the case presentations Use of slides Use of radiographic images Focused analysis of error Focussed on facts de-identified Integration of evidence-based literature into the morbidity and. If not, members should promote the use of properly constituted quality improvement committees. Agenda There is shredder a limited evidence regarding agenda. Some evidence to suggest that an agenda that includes appropriate documentation to inform the mmr committee and support decision making should be circulated one week before each meeting to ensure that members have time to consider the contents and raise questions they may have before. Minutes There is limited evidence regarding mmr minutes. There is some evidence that minutes of each meeting should be prepared, circulated and retained as the complete and formal record of each meeting of the mmr committee (Appendix 3). The minutes of each meeting should be confirmed or amended and confirmed at the next ordinary meeting of the mmr committee (Appendix 3).
Tips: Primary questions to consider for each case database are: What happened? If there was dates a breach of a standard of care or an error, why did it happen? What can be done to prevent a recurrence? What went wrong (or right)? How did it go wrong (or right)? Why did it go wrong (or right)? What could we do differently in future?
Onsite or in a seminar lecture room have been suggested. How the case is presented/analysis, case presentations vary in structure. Sbar format (Situation, background, Assessment and Analysis, recommendation) most structured and best evaluated. Other guidelines include: presenting using a structured format, terms of reference, purpose, reporting structure, scope of activities and membership all outlines at beginning of meeting. The Chairperson is responsible for creating an atmosphere that is conducive to open discussion and should ensure all members have an opportunity to contribute; focus should be placed on identifying the issues related to any processes or systems of care that contributed to the death. Discussions should consider if any measures may be recommended or implemented to prevent a similar incident or adverse outcome. Not all cases need to result in recommendations. Consider using a fishbone diagram or Vincent's model to assist in identifying causative factors.
Methodology, from Our Experts
Additionally, 30 minutes per case has also been used. Of note, mmrs have been reported to go from plan 20 minutes up to 4 hours 1,. Who leads, it is suggested that leaders should have high skills and expertise in the area of morbidity and mortality cases. Leaders should be trained or have skills in auditing, ability to understand and interpret the clinical information accurately, ability to access senior medical advice, understanding of environment. Leaders may include; consultants, physicians or senior doctors or nurses however, this role could be performed by any suitably trained staff member with access to senior medical advice as required.
Recent review suggests there is no fixed or determined way of convening mmrs, that is, no clear indicator as to whether they need to be convened by a designated individual or role (e.g. The head of a department or even a set procedure for what slavery is typically a forum. Who attends, who attends Most of the literature employs a multidisciplinary team 1, 5, 6, 11, 14-17, 19,. Participants may include any of the providers involved in the care of the patient, selected experts, and others who can contribute to the analysis of the event and to the development of practical recommendations to improve patient safety24. These people include: Nominated Clinician (Chair Executive director, medical Services and Chief Medical Officer, director Medical Services, Program Directors, surgery, perioperative and Ambulatory services, Emergency and Acute medicine, womens and Childrens, medical Unit heads, Clinical Service directors, manager Operations, risk manager, Clinical Risk coordinator, Pharmacy. Location, generally not stated.
In addition to these, medico-legal, cases with the possibility of quality improvement or those with some form of educational variable, including identifying cases with outstanding outcomes for discussion and case learning have also been selected as suitable for mmrs. Previous review suggests an average of three cases per meeting 20, and recent literature supports this. How the meeting is conducted, when. There is no clear consensus and it is variable. Number of reported cases can determine frequency. Options used are: within a week of event, whenever practical within days of the event, within 24 hours of event, weekly 1, 4, 11, 12, 15, 17, 18, monthly 1, 5, 8, 9, 11, 13, 14, 22, bimonthly 11, three-monthly. There has not been empirical evaluation of timing. How long, evidence regarding meeting duration varies however, 15 min presentation with 5 minutes questions has been implemented 8,.
Literature, review in Research, methodology, tips and
Outcomes of Morbidity and Mortality reviews (Patient centered care). There is very limited evidence in the literature evaluating outcomes or measurements of patient centered care as a writing result of mmrs It has been reported that in surgical departments, mandatory mmrs result in a 40 decrease in gross mortality over 4 years. Previous reviews have described other literature on the effectiveness of specific mmr approaches and identified mmrs to be effective in identifying and engaging clinicians in system improvements, reducing deaths from cholera, and creating a safe forum for discussion of errors for junior medical staff, including. Recent research however, has identified improvement in outcomes around decreased mortality rates 10, 21, reduction in medical malpractice claims 11, clinician satisfaction 17, 18, 22, improved safety culture 19, 23, and quality of care 21,. Most common features for conducting Morbidity and Mortality reviews. The most common features identified from the literature for conducting mmrs have been summarised (Table 1 and categorised under the following headings: Purpose of mmrs, case selection/types of cases, conduct of meetings (when the meetings are held, for how long, who leads, who attends, what. How the process is convened (by who, terms of reference, agendas, minutes). Governance integration, follow up processes of reviews, table.
has been a recent comprehensive review conducted on mmrs from inception until 2009 done on behalf of the victorian Department of health and Human Services. We have included this review in our report findings. Only documents that covered the mortality review process in a hospital setting were included however, items that included "mortality" and "morbidity" were not excluded. Results, the search of the databases identified 827 citations of which 27 full text were retrieved. The search of the grey literature identified 256 results. Fifteen documents met the inclusion criteria. A total of 33 documents are included in this review (18 peer reviewed articles and 15 items of grey literature). The included documents are from national and international settings and cover hospital wide disciplines.
Morbidity and Mortality reviews (MMR) provide an open, collaborative and transparent review process for clinicians to examine practice and identify areas of improvement such as patient outcomes essays and adverse events without fear of blame or individual focus 1-3. Historically, mmrs are commonly conducted in surgical departments as a mode of clinical education and a way of reviewing and improving practice 4-9. However, this process has been conducted in a variety of settings such as: acute care 10, 11, community medical centres 12, emergency departments 13, general medical divisions 1, intensive care unit 14, and palliative care. In addition to this, there have been a number of investigations exploring the use of mmrs hospital-wide 16-19. At Monash health, we decided to examine the literature surrounding best practices for conducting morbidity and mortality reviews. Specifically we asked: What outcomes have been used to evaluate mmrs (Patient centered care)? What are the most common features of mmrs?
Literature review in research methodology pdf - galea
Best practice for conducting morbidity and mortality reviews: A literature review. Introduction, patch Adams md once said of the role of doctors: "Our job is improving the quality of life, not just delaying death." That statement is truer today than ever before. Mankind now has greater means to prolong the life of patients through the use of sophisticated machines and new technologies. Nevertheless, patients do die, and sometimes they die because of avoidable medical errors. Therefore, we are duty bound to review such deaths, so that we learn from these mistakes and prevent them from happening again to another patient. As Publiliu syrus, the latin writer born 85 bc said: "From the errors of others, a general wise man corrects his own." And the wise medical leader will want to put systems in place to ensure the health service he or she is leading learns from. All of us are aware that preventable hospital mortality is a critical public health issue, particularly when mortalities are associated with events that are preventable. As a result, there is a clear need for medical leaders to put in place rigorous, systematic and effective processes to enable the assessment of quality of care in a timely manner.