Morbidity & Mortality Conference

UCLA Morbidity & Mortality Conference

The purpose of this conference is to provide an educational forum for the open discussion of the perioperative and intraoperative aspects of patient care. Such discussion will provide resident physicians the opportunity to critically review various aspects of patient care, to be exposed to contemporary principles guiding surgical decision-making, and insight into the processes of improving the quality of care. This conference is an essential component of the educational process necessary for the training of residents and a requirement for accreditation by the Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education (ACGME).

Attendance to this conference is considered a compulsory component of participation in the educational program for both faculty and residents alike. Confidentiality regarding the discussion conducted during this conference is expected.

The following criteria for case reporting to the conference will be used:

•  It is the administrative responsibility of the service chief or senior resident to report the required data on a weekly basis online at http://surgery.ucla.edu/site.cfm?id=245 (accessed at www.surgery.ucla.edu, then selecting CADO Form) by 7AM on Wednesday mornings. The data required is the average daily census (C) of the service, the number of hospital admissions (A) and discharges (D) to and from the service, the total number of inpatient and outpatient operative cases (O) performed, and the number of complications and deaths. This must be reported for U, C, L/A, Pediatric Surg, Endocrine, OV, SMH, and the VA.

• The data accrual period is the seven (7) calendar days preceding the date of the conference. In the event that a weekly M&M conference is postponed, or cancelled, the data must still be reported. In the event that all prepared slide presentations are completed with time in the hour remaining, complications reported in the weekly CADOs may be selected for simple oral presentation at the discretion of the conference moderator.  This informal presentation will still count as a full M&M presentation for the resident.

• Cases will be selected for presentation based on broad applicability/educational value, necessity for quality review (NSQIP database), and need to distribute resident participation.  For this reason, all events should be reported regardless of current patient status immediately using the M&M reporting template (Word document) for UCLA sites. The VA and OV have their own forms and these are also acceptable.  Forms must be e-mailed to Hallie Chung  (hachung@mednet.ucla.edu) and Chantal Williams (cniwilliams@mednet.ucla.edu).  If selected for presentation, forms must be submitted by 8AM the Monday morning preceding Wednesday conference to allow the moderator time for review.

Note:  There should be no reason to withhold M&M report submissions with concern that it will induce more work for the resident.  All senior residents are required to present, the more presentations that are submitted by an individual resident, the more cases that resident and the Quality Review Committee have to choose from. Those presentations with little educational value can then easily be taken off the list.

Reportable events are defined as the following:                                                                                                       

1. Unplanned need for secondary operation, whatever the nature.
2. Unanticipated admissions to any acute care facility within 30 days of discharge.
3. Unanticipated significant escalation of care required.
4. Death

The chief or senior resident involved in the critical aspects of the perioperative care, primarily the decision for operation and the operation itself will make the presentation of the case. This includes clinical training years III to V only. In the event, that the involved resident is no longer on service, that individual will still be responsible for the presentation of the case.  Cases of particular educational value that are performed by junior residents will be presented by the supervising chief resident.

The appropriate clinical data and imaging studies will be available for presentation, keeping this information to minimal pertinent data only.  The presenting resident is expected to have reviewed the case, considered the possible causes of the complication and potential approaches in which the complication could be avoided in the future.  Best evidence from the literature should be presented. The resident will utilize the SBAR powerpoint template for event reporting, with specific focus on the root cause analysis "fish bone" diagram.