Quality assurance and morbidity and mortality conference

Many surgeons assert that Morbidity and Mortality (M & M) conference in itself assures an effective quality assurance (QA) program. Recent emphasis on QA in other sectors has resulted in other processes for evaluating quality of care. The goals of QA programs are to identify adverse patient care events, relate these to specific physicians and use this information to improve patient care, and for credentialing and privileging physicians. Our aim was to determine the role of surgical M & M conference in a QA program which also includes occurrence screening, wound infection surveillance, and surgical case review. The weekly M & M conference is a discussion of identified complications and deaths submitted voluntarily by surgeons. During a 2-year period 5755 procedures were associated with 255 complications and 82 deaths. Only 74% of events identified by occurrence screening, 35% of cases identified by surgical case review, and 54% of wound infections had been submitted to M & M conference. Seventy-four percent of surgical residents and 33% of staff surgeons were present at M & M conference when their complications were discussed. Level of care (I, accepted practice; II, may have managed differently; and III, would have managed differently) was assessed for each complication at M & M conference and by peer review of the medical record for occurrence screening. The assignment of level of care was similar by either process (I = 49, II = 11, III = 2, at M & M vs I = 44, II = 16, III = 2, r = 0.7405, P < 0.005). M & M conference remains an important component of an overall QA program but does not meet all of the goals. There is excellent agreement between level of care assigned at M & M conference compared to peer review of the medical record. However, many adverse events identified via other processes are not reported at M & M conference. In our experience, physicians are often not present when their complications are discussed.