How to manage a mortality/morbidity meeting (MMM)? T. Pottecher

What is this? Morbidity/mortality meeting is: Analysis of all deaths Analysis of some unexpected issues

How to do it? Meeting with all physicians, but other professionnels ( nurses, physiotherapist, …) involved are concerned

Who is concerned ? Inviting other physicians (from elsewhere) is seldom performed In routine practice, MMM is an efficient tool for improvement of practices

MMM is not… Self defence or self satisfaction, Court in which the physician in charge of unexpected event may feel guilty, Meeting in which real problems will not be discussed.

Backwards…. Used in US (since 1920) as a pedagogic tool Initiated in surgery Progressive extension to other specialities and countries French experiences only seldom Initiated by teams (surgery, anesthesiology, intensive care,….) Now recommended by HAS (V2) (French High Health Autority )

Theory Practice

How to organize? Written document explaining : Occurrence and meeting duration Interest for attendants(EPP Value) How cases are choosen Who are expected attendants Written report Improvements expected

Main objective? Examin, with criticism, how the patient was cared Was the unexpected event avoidable? Together, try to explain why the unexpected event has occured

Expected result? Define what must be done to avoid a new case with this unexpected issue. Improvement actions must be decided and planned Define who is in charge, objectives and landmarks of improvements

Questions to answer in case of unexpected event (1) What did really occur? Define dommage and consequence Analysis of event’s chain leading to unexpected event?

Questions to answer in case of unexpected event (2) Obvious causes? Is the event related to medical product or to unadapted process? Is there any human factor in the event: Did professional do what they are supposed to do? Did professionnel knew what they had to do? Could a better supervision avoid this event?

Questions to answer in case of unexpected event(3) Hidden causes? Organization, responsabilities …really explained? Was communication between care givers efficient? Was health care team composition adapted to work load? Equipments …..adapted? Lack of security culture?

Questions to answer in case of unexpected event(4) Preventive measures : Is the prevention system efficient? What conclusion to avoid this event?

Deming’s wheel… Do : decide to explore unexpected events Analyse : Unexpected issues are analysed; Improve : Care givers will improve their organization and pratices to reduce the risk of unexepcted event Plane : Organize care to avoid this event and decide of landmarks which will be measured

Theory Practice

Organization of MMM in a universitary unit of anesthesiology

Mercredi 4 novembre 2009 à 16 h salle de réunion d’anesthésie – Hôpital de Hautepierre Information

Report

Jeudi 22 avril 2010 à 14 h 30 Colloque du niveau 4 – Hôpital de Hautepierre Information

To improve discussion

Mardi 29 juin 2010 à 16 h 00 salle de réunion d’anesthésie – Hôpital de Hautepierre

SAOS connu SAOS suspecté (SAS >15) CPAP disponiblePas de CPAP SSPI durée habituelle SSPI prolongée de 3 h Selon chirurgie: Ambul,service, soins continus Surveillance continue ou SSPI (24h) Risque postop + Risque postop - SSPI durée habituelle Selon chirurgie: Ambul,service, soins continus complication RAS complication New procedure

Mercredi 8 décembre 2010 à 16 h 00 salle de réunion d’Anesthésie – Hôpital de Hautepierre Information

Jeudi 9 juin 2011 à 17 h 00 salle de réunion d’Anesthésie – Hôpital de Hautepierre

To conclude, Initially feared by physicians – Personnal conflicts – Medicolegal consequencies Today, well accepted – No conflicts between physicians – Practical consequencies evident for anyone

Try it… It’s like russian baths you w’ll quickly adopt it…