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“Best Practice for conducting morbidity and mortality reviews: a literature review”

Authors: Corey J, Garruba M, Melder A, Loh E.   Published: The Quarterly 2015.

With great interest I read the article by Corey Joseph et al “Best practice for conducting morbidity and mortality reviews: A literature review” which was published in the September 2015 issue of the Quarterly. The article describes the importance of regular Morbidity and Mortality Reviews (MMRs) and their value in improving patient safety and quality of care. [1 -2] The authors state that MMRs should consist of a multidisciplinary team being led by a skilled and experienced leader in the discipline.

Although I certainly agree with the proposed concept it is immediately clear that implementing these recommendations for our regional remote hospital is difficult, mainly due to the lack of hospital employed senior medical staff. Many disciplines are staffed by Visiting Medical Officers (VMO’s) who are reluctant to attend MMR meetings despite tremendous efforts in all aspects by the hospital administration and agreed remuneration. In many disciplines in our hospital the MMRs occur on an irregular basis. Some are organised at a time that suits the VMO’s, often after hours, which makes the attendance of other disciplines and (junior) staff members more difficult. This impairs the teaching and quality improvement aspect of the MMR’s. In general, the MMR’s are better organised in departments which have a Director of the service, i.e a Staff Specialist. It is also hard to enforce the attendance of the VMO’s to the MMR’s as there is no clear mandate in their current award.

A study by Mitchell et al and the toolkit by the SAFE anaesthesia liaison group both recommend mandatory MMR attendance for all residents and faculty. [3-4] A recommendation to the Ministry of Health and the Area Health Services could therefore be made to consider a change in the VMO award to make attendance at MMR’s mandatory.

I would further like to emphasize that efficient MMR’s requires discussion with peers. Some disciplines in our hospital have only one senior staff member. Consideration for teleconferencing with other sites or attendance by other visiting specialists should be considered. This was recommended in the surgical audit and peer review guide by the Department of Professional Standards of the Royal Australasian College of Surgeons. [5]

I look forward to hearing the thoughts and suggestions of my colleagues on these important points.

Dr Osama Ali

1. Deis, J et al. Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement, in Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign). K. Henriksen, et al., Editors. 2008, Agency for Healthcare Research and Quality (US): Rockville (MD).
2. Sellier, E et al. Morbidity and mortality conferences: their place in quality assessments. International Journal of Health Care Quality Assurance, 2012. 25(3): p. 189-96
3. Mitchell EL et al. Improving the quality of the surgical morbidity and mortality conference: a prospective intervention study. Acad Med 2013;88:824–830.
4.  SAFE anaesthesia liaison group, 2013. Anaesthesia Morbidity and Mortality meetings: A Practical Toolkit for Improvement. Retrieved May 2015 from https://www.aagbi.org/sites/default/files/SALG-M%26M-TOOLKIT-2013_0(1).pdf
5. Royal Australasian College of Surgeons Department of Professional Standards, 2008. Surgical audit and peer review. Retrieved May 2016 from http://www.surgeons.org/media/66599/surgical_audit_peer_review.pdf

Last Updated on Wednesday, 12 April 2017 17:00