Combining Quality Measures to Improve Surgical Outcomes

Combining Quality Measures to Improve Surgical Outcomes 150 150 Kevin Mayhood

Use a refined morbidity and mortality conference with a national database, a new study suggests.

A pediatric surgery morbidity and mortality (M&M) conference that applies quality improvement practices borrowed from industry can be a significantly more effective tool for learning from mistakes and making corrections, researchers from Nationwide Children’s Hospital show in a new study.

In parallel, the National Surgical Quality Program-Pediatrics (NSQP-P) identifies nearly twice the number of complications, the study found.

To give a hospital the best opportunity to make improvements, use both, the researchers say. “Each has their advantages,” says Gail Besner, MD, chief of Pediatric Surgery and principal investigator in the Center for Perinatal Research at Nationwide Children’s. “If your hospital utilizes both systems in combination, then you can really improve the quality of health care you deliver.”

Dr. Besner, who was appointed surgery chief five years ago, noticed that the same type of complications were being presented in the M&M conference month after month. She and colleagues borrowed from the airline and manufacturing industries’ methods for analyzing failure and tailored the process to determine whether patient complications were due to an individual’s mistake or to system errors.

M&M conferences are held weekly to discuss complications reported in any patient – a portion of whom don’t qualify for NSQP-P reporting. Surgeons and other health care workers collaborate to analyze the issues, determine the cause of the complication and initiate corrective measures to be expeditiously completed.

Over time, the number of repeat complications has decreased, processes found to be problematic have been eliminated and medication formularies and equipment carts have been modified – all to decrease preventable patient harm in the future.

Dr. Besner, who is also a professor of Surgery and Pediatrics at The Ohio State University College of Medicine, and colleagues compared the refined QI-directed M&M conference and NSQP-P in a recent issue of the Journal of the American College of Surgeons.

NSQP-P is a national database that prospectively collects outcome data and allows comparisons with other hospitals. Over the course of the five-year study period, NSPQ-P identified 194 events per 1,000 patients whereas the M&M conference identified 100 per 1,000. The researchers found no differences in reporting for wound, neurologic and renal complications, but NSQP-P identified higher rates for respiratory, cardiovascular and other infectious complications, as well as readmissions.

As the number of samples grows over time, they reflect the hospital’s experience with patients as a whole, the researchers say. The database is ideal for comparing variables between large cohorts of patients to identify and track areas of improvement.

“The more cases we review in M&M, the more action initiatives directed at improving the system we can put in place,” says Brian Kenney, MD, MPH, surgical director for Quality Improvement, member of the pediatric surgical team at Nationwide Children’s, associate professor of Pediatrics at OSUCOM and study co-author. “The two systems are complimentary.”



Cromeens BP, Lisciandro RE, Brilli RJ, Askegard-Giesmann JR, Kenney BD, Besner GE. Identifying adverse events in pediatric surgery: comparing morbidity and mortality conference with the NSQIP-Pediatric systemJournal of the American College of Surgeons. 2017 May;224(5):945-953.

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