Impact of morbidity and mortality conferences on patient outcome

Abstract

Introduction Despite decades of morbidity and mortality conference (MMC) research studies, there is still limited evaluation of their effect on healthcare outcome, especially in ICUs. Aim The aim of this study was to explore the effectiveness of goal-directed multidisciplinary MMCs on mortality and adverse event rates. Patients and methods A 4-year retrospective study was conducting in two ICUs for evaluating a systematized MMCs with a clear goal of improving local care through case discussion, analysis, brainstorming, and clear recommendations or action plans in a multidisciplinary meeting involving all related caregivers in a blame-free environment. This study included four phases: preintervention (January 2012–April 2013), intervention (May–June 2013), postintervention (July 2013–October 2014), and washout period (November 2014–December 2015, after MMC stoppage). A period prevalence study of ICU-acquired adverse events was done in March 2013, December 2013, and March 2015, in addition to monthly ventilator-associated pneumonia, catheter-associated blood stream), and catheter-associated urinary tract infection rates. Results A total of 5308 patients were included in this study, of which 1396 (26.3%) died. During the intervention and postintervention phases, 18 MMCs were held, which discussed 49 cases (38; 77.6% from ICU3 and 11; 22.4% from ICU1), reviewed other causes of death and unit performance indicators, and made 96 recommendations (85% accomplished in ICU3 vs. 55% in ICU1). All-cause combined and ICU3 mortality rates decreased after MMC implementation and then increased after MMC stoppage, with nonsignificant differences between the three groups regarding age, Acute Physiological and Chronic Health Evaluation II score, or primary diagnosis. Unexpected cardiac arrest (ICU3) and unplanned extubation (ICU1) decreased significantly with MMC and then increased significantly after MMC, whereas ICU-acquired gastrointestinal bleeding, deep vein thrombosis, and pneumothorax did not differ significantly across the three phases. Ventilator-associated pneumonia (ICU3), blood stream infection (ICU1), and urinary tract infection decreased significantly with MMC without significant change after MMC stoppage. Conclusion Goal-oriented multidisciplinary MMC reduced adverse events and probably mortality rate in medical/surgical ICU. Discrepancies between both units emphasized the need for continuous monitoring and tailoring of MMC system in case selection and recommendation implementation.