Guidelines [Neurosurgery Wiki]

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The Royal College of Surgeons emphasizes the importance of regular attendance at M&M meetings for all surgeons as a key activity for reviewing team performance and ensuring quality.

Their guidance provides practical advice on setting up, running, and participating in high-quality surgical M&M meetings.

**Benefits**

Engaging in M&M meetings offers several advantages:

- **Enhanced Patient Safety:** By identifying and addressing potential risks, clinicians can implement preventive measures.
- **Professional Development:** These meetings serve as a platform for continuous learning and improvement.
- **Team Cohesion:** Facilitating open discussions fosters collaboration and trust among team members.

In summary, M&M meetings are integral to neurosurgical practice, promoting a culture of safety, learning, and quality improvement. 

Implement quality improvement initiatives based on lessons learned from cases.
Develop or modify protocols and guidelines to enhance patient safety and care delivery.

Guidelines for conducting M&M conferences in community hospital NICUs are limited, emphasizing the need for structured case overview methods.
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===== Guidelines =====

Although individual [[hospital]]s, and the Accreditation Counseling for Graduate Medical Education all require these regularly scheduled formal peer-reviewed M&M conferences, a great deal of heterogeneity exists in how M&Ms are conducted across the [[healthcare system]]
((Rotman LE, Davis MC, Salehani AA, Broadwater DR, Reeve NH, Riley KO. Discrepancy
Between Neurosurgery Morbidity and Mortality Conference Discussions and Hospital
Quality Metric Standards. World Neurosurg. 2018;115:e105-e110.
doi:10.1016/j.wneu.2018.03.195.))
((Ferreira K, Lynch K, Ryder B, Connolly M, Miner T, Harrington D. Lessons Learned
From the Surgical Morbidity and Mortality Conference. J Surg Educ. 2018;0(0):1-8.
doi:10.1016/j.jsurg.2018.07.002.))
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Only one discussed recommendations on how to conduct and improve morbidity and mortality conferences, but this study was not conducted within a community hospital NICU
((Assaad MA, Janvier A, Lapointe A. Using internal and external reviewers can help to optimise neonatal mortality and morbidity conferences. Acta Paediatr. 2018 Feb;107(2):283-288. doi: 10.1111/apa.13889. Epub 2017 May 19. PMID: 28437573.)).
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Despite the history of morbidity and mortality review (MMR), there is limited information published on guidelines for community hospitals in the United States, and there are no published recommendations on how to format an MMR conference for a community hospital NICU. An advanced search of PubMed on 6/8/2023 using the search terms “morbidity and mortality conference” located in the title and/or abstract with filters for the English language and human species found 175 published articles. 
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The surgical specialties most commonly referenced “Morbidity and Mortality Conference” in their publications (81 articles) followed by internal medicine (31 articles) and emergency medicine (14 articles). A few articles were written from an interdisciplinary perspective including surgery and internal medicine disciplines (2) while other articles provided general recommendations for all medical disciplines 
((Pang S, Warraich HJ. Humanizing the morbidity and mortality conference. Acad Med. (2021) 96(5):668–70. 10.1097/ACM.0000000000003901))
((Lazzara EH, Salisbury M, Hughes AM, Rogers JE, King HB, Salas E. The morbidity and mortality conference: opportunities for enhancing patient safety. J Patient Saf. (2022) 18(1):e275–81. 10.1097/PTS.0000000000000765))
((Giesbrecht V, Au S. Morbidity and mortality conferences: a narrative review of strategies to prioritize quality improvement. Jt Comm J Qual Patient Saf. (2016) 42(11):516–27. 10.1016/S1553-7250(16)42094-5))
((Gregor A, Taylor D. Morbidity and mortality conference: its purpose reclaimed and grounded in theory. Teach Learn Med. (2016) 28(4):439–47. 10.1080/10401334.2016.1189335))
((Prasad V. Reclaiming the morbidity and mortality conference: between codman and kundera. Med Humanit. (2010) 36(2):108–11. 10.1136/jmh.2010.003848))
((Goolsarran N, Garcia C. Changing the culture of the morbidity and mortality conference. Med Educ. (2016) 50(11):1159–60. 10.1111/medu.13199))
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The establishment of a [[case overview]] method of MMR is feasible for a community hospital NICU. It increases staff and physician group awareness and education over common and complex mortality and morbidity etiologies, improves staff participation with unit management, links case presentations with open discussion and action items, and identifies opportunities for systemic changes to improve patient care
((Chan C, Pazandak C, Angelis D. Implementation of morbidity and mortality conference in a community hospital NICU and narrative review. Front Pediatr. 2023 Dec 1;11:1321296. doi: 10.3389/fped.2023.1321296. PMID: 38105790; PMCID: PMC10722255.)).
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In neurosurgery, these conferences focus on both favorable and unfavorable outcomes of specific cases. The primary goals are to promote learning, improve patient care, and enhance the overall quality and safety of neurosurgical practices.

Key Components of M&M Conferences in Neurosurgery:

Identification of Cases:

Discuss favorable outcomes (morbidity) and unfavorable outcomes (mortality).
Presentation of Cases:

Provide relevant patient information, medical history, diagnostic details, and surgical interventions.
Describe the clinical course, including the sequence of events, complications, and outcomes.
Objective Analysis:

Identify contributing factors, both systemic and individual, influencing the outcome.
Conduct root cause analysis to identify underlying causes of adverse events or complications.
Interactive Discussion:

Encourage multidisciplinary participation, including neurosurgeons, residents, nursing staff, and anesthesiologists.
Foster an open, non-punitive environment for team members to discuss challenges and propose improvements.
Learning Opportunities:

Emphasize the educational aspect, providing continuous learning and skill enhancement opportunities.
Use case-based teaching to convey important neurosurgical principles, techniques, and approaches.
Quality Improvement Initiatives:


Patient-Centered Care:

Ensure discussions remain patient-centered, focusing on improving care and preventing similar occurrences.
Confidentiality and Privacy:

Emphasize the importance of maintaining patient confidentiality during discussions.
Challenges and Recommendations:

Despite the valuable information obtained from M&M conferences, data collection is not systematically organized, limiting comparisons between hospitals or time periods.
Four archetypes of patient outcomes have been described: expected successes, unexpected failures, unexpected successes, and expected failures.

In conclusion, Morbidity and Mortality Conferences, especially in neurosurgery, play a vital role in promoting a culture of continuous improvement, learning, and patient safety. These conferences provide a platform for healthcare professionals to collaboratively analyze cases, share insights, and implement changes for enhanced patient care. Ongoing efforts to structure case overviews and improve data collection methods contribute to the overall effectiveness of these conferences in healthcare institutions.
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A "[[Morbidity]] and [[Mortality]] [[Meeting]]" (often referred to as M&M meeting or M&M conference) is a specialized type of medical or healthcare conference. These meetings are commonly held in hospitals or healthcare institutions and are designed to review and discuss specific cases of patient morbidity (illness) and mortality (death).

The primary objectives of Morbidity and Mortality Meetings include:

[[Case Review]]: Healthcare professionals, such as doctors, surgeons, nurses, and other relevant staff, gather to review specific cases in which patients experience adverse outcomes or unexpected events. These cases could involve complications, errors, or other significant medical events.

Learning and Improvement: The focus is on learning from these cases to improve patient care and safety. By analyzing what went wrong or could have been done differently, healthcare providers aim to identify areas for improvement in clinical practices, procedures, and protocols.

[[Quality Assurance]]: M&M meetings play a crucial role in the quality assurance process within healthcare institutions. They provide a forum for healthcare professionals to assess and ensure the quality of care provided to patients.

Professional Development: These meetings contribute to the ongoing professional development of healthcare practitioners. They encourage a culture of continuous learning and self-reflection.

Risk Management: M&M meetings are a component of risk management strategies in healthcare. By identifying and addressing issues that lead to adverse outcomes, healthcare organizations can work to mitigate future risks.

The discussions during Morbidity and Mortality Meetings are often confidential and non-punitive, focusing on systemic issues and opportunities for improvement rather than blaming individual practitioners. These meetings are considered essential for maintaining a high standard of patient care and promoting a culture of safety and continuous improvement within healthcare settings.
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Medical institutions use [[quality metrics]] to track [[complications]] seen in hospital [[admission]]s. Similarly, [[morbidity]] and [[mortality]] (M&M) conferences are held to peer review [[complication]]s. 
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[[Morbidity]] and [[Mortality]] (M&M) [[conference]]s are [[peer-review]]ed and medicolegally protected [[forum]]s for presenting and discussing [[complication]]s, elucidating potential sources of [[error]], assigning and classifying [[blame]], and educating [[faculty]], [[resident]]s, and other ancillary staff.
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In [[neurosurgery]] it is a regular [[meeting]] where healthcare professionals, particularly those in the field of neurosurgery, gather to discuss and review specific [[case]]s, focusing on both favorable and unfavorable [[outcome]]s. The primary goals of these conferences are to promote [[learning]], improve [[patient care]], and enhance the overall [[quality]] and [[safety]] of neurosurgical [[practice]]s. 

Identification of Cases:

Favorable Outcomes (Morbidity): Discuss cases with unexpected complications, adverse events, or suboptimal results.

Unfavorable Outcomes (Mortality): Review cases that resulted in patient mortality.

Presentation of Cases:

Background Information: Provide relevant patient information, medical history, diagnostic details, and surgical interventions.

Clinical Course: Describe the sequence of events, complications, and outcomes during the patient's course of care.

Outcomes: Discuss the outcomes, including any morbidity or mortality associated with the case.

Objective Analysis:

Identify Contributing Factors: Examine the contributing factors, both systemic and individual, that may have influenced the outcome.

Root Cause Analysis: Conduct a root cause analysis to identify the underlying causes of adverse events or complications.

Interactive Discussion:

Multidisciplinary Participation: Encourage participation from neurosurgeons, residents, nursing staff, anesthesiologists, and other relevant healthcare professionals.

Open Discussion: Foster an open and non-punitive environment where team members can openly discuss challenges, share insights, and propose improvements.

Learning Opportunities:

Educational Focus: Emphasize the educational aspect of the conference, providing opportunities for continuous learning and skill enhancement.

Case-Based Teaching: Use specific cases to teach important neurosurgical principles, techniques, and approaches.

Quality Improvement Initiatives:

Quality Assurance: Implement quality improvement initiatives based on lessons learned from the cases discussed.

Protocol Development: Develop or modify protocols and guidelines to enhance patient safety and care delivery.


Patient-Centered Care:

Patient Advocacy: Ensure that the discussion remains patient-centered, focusing on how to improve care and prevent similar occurrences in the future.

Confidentiality and Privacy:

Protect Patient Confidentiality: Emphasize the importance of maintaining patient confidentiality during discussions.

Morbidity and Mortality Conferences play a crucial role in promoting a culture of continuous improvement, learning from experiences, and enhancing patient safety in neurosurgery and other medical specialties. They provide a platform for open communication, collaboration, and ongoing professional development among healthcare providers.
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Although data from M&M conferences can yield valuable information regarding trends in morbidity, and can potentially uncover areas in need of improvement, this data is typically not systematically all collected or stored
((Seely AJE, Ivanovic J, Threader J, et al. Systematic Classification of Morbidity and Mortality After Thoracic Surgery. ATS. 2010;90(3):936-942. doi:10.1016/j.athoracsur.2010.05.014.)).

Subsequently, a comparison of complication rates between different hospitals, or even between different time periods within the same institution, is usually not possible
((Landriel Ibañez FA, Hem S, Ajler P, et al. A New Classification of Complications in Neurosurgery. World Neurosurg. 2011;75(5-6):709-715. doi:10.1016/j.wneu.2010.11.010.))
((Antonacci AC, Lam S, Lavarias V, Homel P, Ph D, Eavey RD. A Morbidity and Mortality
Conference-Based Classification System for Adverse Events : Surgical Outcome
Analysis : Part I. 2008;177:172-177. doi:10.1016/j.jss.2008.02.054.))
((Bortz CA, Passias PG, Segreto FA, et al. Grading of Complications After Cervical
Deformity-corrective Surgery Are Existing Classification Systems Applicable ? 2018;0(0):1-6.)).
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There are four different archetypes of patient outcomes that have been described:
expected successes, unexpected failures, unexpected successes, and expected failures
((Bohnen JD, Chang ÃDC, Lillemoe KD. Reconceiving the Morbidity and Mortality Conference in an Era of Big Data. Ann Surg. 2016;263(5):2015-2017. doi:10.1097/SLA.0000000000001508.))
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[[Morbidity]] and [[mortality]] (M&M) [[conference]]s are traditional, recurring conferences held by medical [[service]]s at [[academic]] medical centers, most large private medical and surgical practices, and other [[medical center]]s. 

Death, deterioration and complications may be unavoidable in some patients due to underlying disease processes. However they may also be associated with [[error]]s or [[omission]]s in [[patient care]]. M&M conferences involve the analysis of [[adverse]] outcomes in patient [[care]], through [[peer review]]. The objectives of a well-run M&M conference are to identify adverse outcomes associated with medical error, to modify behavior and judgment based on previous experiences, and to prevent repetition of errors leading to complications.

Conferences are non-punitive and focus on the goal of improved patient care. The proceedings are generally kept confidential by law.

M&M conferences occur with regular frequency, often weekly, biweekly or monthly, and highlight recent cases and identify areas of improvement for clinicians involved in the case. They are particularly important for identifying systems issues (e.g., outdated policies, changes in patient identification procedures, arithmetic errors, etc.) which affect patient care.

The results of a survey that endeavored to study the relevance and traits of morbidity and mortality conferences (M&MCs) in the spring of 1998 indicate that 90% of U.S. internal medicine training programs hold M&MCs. The majority of these conferences occur every month, where an assigned leader reviews certain select cases that had unpredicted consequences or a suspected medical error. It was also reported that two-thirds of the hospitals use the M&MCs as a means to fulfill their administrative requirements for quality assurance.