Implementation status of morbidity and mortality conferences in Austrian hospitals-A cross-sectional national survey study

Introduction Morbidity and mortality conferences (M&MCs) are an instrument for learning from past complications, unexpected follow-ups and deaths in hospitals and are important for improving patient safety. However, there are currently no quantitative data on the implementation of M&MCs in Austria. The aim of the study was to determine the status quo of the M&MCs in Austria. Materials and methods A national cross-sectional study was conducted by means of a survey of 982 chief physicians of surgical disciplines, internal medicine, anesthesiology, intensive care, gynecology/obstetrics and pediatrics. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. Results Of the 982 contacted chief physicians, 314 (32.0%) completed the survey. Almost two thirds of the respondents, i.e. 203 (64.7%), had already implemented M&MCs. Of the 111 chief physicians who had not yet introduced M&MCs, 62 (55.9%) were interested in introducing such conferences in the future. Of the 203 respondents that had implemented M&MCs, 100 stated that their M&MC could be improved. They reported issues with "shame and blame" culture, hierarchical structures, too little knowledge about the capability of M&MC and, in particular, time constraints. Overall, the participating chief physicians showed that they are striving to improve their existing M&MCs. Discussion/Conclusion While we found a relatively high number of already implemented M&MCs we also identified a large heterogeneity in the format of the M&MCs. A highly structured M&MC including guidelines, checklists or templates does not only considerably improve its outcome but can also alleviate the main limiting factor which is the lack of time.

Die Bedeutung der interdisziplinären Behandlung von vaskulären Anomalien im Kindesalter

Zusammenfassung Vaskuläre Anomalien gehören größtenteils zu den seltenen Erkrankungen. Sie werden in vaskuläre Tumoren und vaskuläre Malformationen eingeteilt. Fallbesprechungen sind im Rahmen der Morbidity and Mortality Conferences (MMC) in den meisten Kliniken etabliert. Untersuchungen zeigen, dass die strukturierte Methodik einer Fallbesprechung die Wahrscheinlichkeit von möglichen Systemänderungen erhöht. Zudem kann durch die Interdisziplinarität die Wahrscheinlichkeit einer Umsetzung in einem Behandlungsplan erhöht werden. Die MMC sind jedoch stark darauf projiziert, dass ein Fehler oder ein drohender Fehler aufgetreten ist. Trotzdem sind die Erkenntnisse und guten Erfahrungen übertragbar. Im Bereich der seltenen Erkrankungen stehen nicht die Fehlervermeidung, sondern der Erfahrungsaustausch und die optimale Behandlung im Vordergrund. Aufgrund der Komplexität und Individualität des Einzelfalls sind Konsilien oder einzelne Face-to-face-Besprechungen häufig zu unsystematisch und die Meinungen der Experten zu divergent. Interdisziplinäre Fallkonferenzen bieten insbesondere für komplexe Fälle den Vorteil der Bündelung der Kompetenz und der Entwicklung von individuellen Behandlungskonzepten. Ziel ist die zeitnahe korrekte Diagnosestellung, die optimale und individuelle Behandlung und die umfassende Information von Patientinnen und Patienten, Eltern und Zuweiserinnen und Zuweisern. Patienten mit vaskulären Gefäßfehlbildungen und ihren Eltern sollte immer ein multidisziplinär besetztes Behandlungsteam mit Anschluss an eine überregionale Arbeitsgruppe (z. B. AIVA, die Österreichische Arbeitsgruppe für interdisziplinäre Behandlung Vaskulärer Anomalien) zur Verfügung stehen.

Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking.METHODS: A facility based cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants’ opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants’ opinion about the morbidity and mortality conferences.RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations.CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.