Article Review: Morbidity and Mortality Conferences in EM

Residency training programs are required to have Morbidity and Mortality (M&M) Conferences, as mandated by the Accreditation Council of Graduate Medical Education (ACGME). These conferences were originally designed to look at medical errors and unforeseen complications in patient care.

Traditionally, Surgery programs focus on medical error and complications in their conferences. In contrast, Internal Medicine programs tend to focus more on cases because of their intrinsic learning value. Error is less the focus in their conferences. What are the practices of EM residency programs?

This paper reviews a descriptive survey study of M&M Conferences in U.S. EM residency programs.  The response rate was 72% (89 of 128) for the 29-question survey. If you include all the active EM programs out there (n=135), the response rate was 66%.

Results

• Bottom Line: M&M conferences are varied in format, content, and timing.
• Some M&M conferences are alternatively called "Quality Improvement Conference" or "Interesting Case Conference"
• 67% of programs hold M&M monthly, and 15% hold them weekly.
• 33% of M&Ms are attended by nurses and EMS personnel.
• Some programs focus more on pediatrics, others more on trauma, and others primarily on cases where death or error was the outcome.
• 79% of programs have a protocol in place when a medical error is identified.

The authors note that the M&M Conferences are perfect venues to address key ACGME Core Competencies into resident education (especially Practice-Based Learning and Improvement and Systems Based Practice).

The next step is to determine the best models for M&M Conferences and to try to standardize them across all programs.

(click to open a larger image)

For our program at UCSF-SFGH, discussion and suggestions for improvement are framed within the Vanderbilt Healthcare Matrix for improvement health care practices. The matrix includes a 6x6 table with the Institute of Medicine mandates on one axis and the ACGME competencies on the other. Download the Matrix from the Institute for Healthcare Improvement (IHI) website.

Reference
Seigel T, McGillicuddy D, Barkin A, Rosen C. Morbidity and Mortality Conference in Emergency Medicine The Journal of Emergency Medicine. 2010, 38(4), 507-11. DOI: 10.1016/j.jemermed.2008.09.018
.