Peer Review/Presenting Morbidity and Mortality Conference

Abstract

Well-run Morbidity and Mortality (M&M) conferences involve the detailed examination of unfavorable outcomes in patient care through a peer review process. Beginning in 1983, the Accreditation Council for Graduate Medical Education (ACGME) required accredited residency programs to review complications and deaths on a recurring basis. As such, M&Ms. have been mandated educational series that occur regularly at institutions sponsoring residency training programs. ACGME recommends physicians continue pursuing quality improvement well past the completion of residency (ACGME, ACGME program requirements for graduate medical education in emergency medicine, 22). Consequently, many contend M&Ms. are beneficial to large private hospitals without residencies to aid in “practice-based learning and improvement as it investigates and evaluates the care of patients, appraises and assimilates scientific evidence, and continuously improves patient care based on constant self-evaluation and lifelong learning” (ACGME, ACGME program requirements for graduate medical education in emergency medicine, 22).

The origin of M&M conferences began famously in 1904 when Dr. Ernest Amory Codman proposed the evaluation of surgeon competence. He recommended such reports be in a structured and repetitive manner (Gregor and Taylor, Teach Learn Med 28:439–47, 2016). He supported the idea of an end-result card that would be subject to follow-up by a committee. As a result, he lost his staff privileges at Massachusetts General Hospital in Boston. Despite Codman’s transient professional set back, in 1916 his ideas sparked the American College of Surgeons case reporting system for adverse patient outcomes (Gregor and Taylor, Teach Learn Med 28:439–47, 2016). In 1982, ACGME approved special requirements for Emergency Medicine residency training programs. One year later, ACGME required M&Ms.

Clearly, well-run M&M conferences utilize a peer review process that methodically explores adverse patient outcomes on a multidisciplinary level. One of the goals is to identify areas of improvement for clinicians involved in the case. However, they are particularly important for identifying system issues. This evaluation includes the cause of medical error as it applies to judgment, knowledge, communication, documentation, process/workflow, technique, etc. Recently M&Ms. have been recognized as a tool to stimulate quality improvement (QI) in addition to educating health care providers (Szostek et al., Am J Med 123:663–68, 2010). In order to encourage the safety culture of medicine, standardized M&Ms. need to be structured to emphasize both patient safety and QI.