Perioperative Team-Based Morbidity and Mortality Conferences: A Systematic Review of the Literature

Q: What are the key findings of this study?

Perioperative team-based morbidity and mortality conferences across 7 studies showed heterogeneous improvements in education, recognition of avoidable complications (54% vs 23%, P<0.05), and quality improvement.

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Perioperative morbidity and mortality across general, cardiac, pediatric, and surgical oncology patients. Intervention: Perioperative team-based morbidity and mortality conferences (TBMMs) vs. Single-discipline morbidity and mortality conferences or pre-implementation baseline. Primary outcome: Impact on patient safety, educational, and quality improvement outcomes.

Q: What does this research mean for the field?

Perioperative team-based morbidity and mortality conferences improve trainee education, the recognition of avoidable complications, and quality improvement outcomes across surgical care settings. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify key operational elements of perioperative team-based morbidity and mortality conferences and assess their impact on patient safety, clinical education, and quality improvement.

Aubrey Samost-Williams; Roni Rosen; Alexander A. Hannenberg; Melis Lydston; Garrett M. Nash; Mary Brindle

doi:10.1097/as9.0000000000000321

August 23, 2023Annals of Surgery OpenOpen Access

Perioperative Team-Based Morbidity and Mortality Conferences: A Systematic Review of the Literature

View Full Paper

Ask AI

Bookmark

Share

Key result

Team-based perioperative M&M conferences more than double the recognition of avoidable complications.

54% vs 23%
P<0.05

Figures

Why the study?

Perioperative patient safety is influenced by system, team, and individual behaviors, yet single-discipline morbidity and mortality conferences remain the mainstay of educational and quality improvement efforts.

Do perioperative team-based morbidity and mortality conferences (TBMMs) improve patient safety, clinician education, and quality improvement outcomes compared with single-discipline conferences or pre-implementation baselines in the perioperative setting?

Key Points

To identify key operational elements of perioperative team-based morbidity and mortality conferences and assess their impact on patient safety, clinical education, and quality improvement.
Conducted a systematic literature search across six databases (MEDLINE, Embase, Web of Science, ClinicalTrials.gov, Cochrane CENTRAL, and ProQuest) in July 2022.
Screened 779 citations, reviewed 47 full-text articles, and synthesized data from 7 qualifying studies (1 national survey, 2 pre-post, 3 retrospective, and 1 mixed methods).
Assessed study quality using the Newcastle-Ottawa Quality Assessment Scale, with included studies scoring 4 or 6 stars out of 9.
Key conference components spanned pre-meeting case investigation and selection, standardized presentation formats with formal moderators during meetings, and post-conference protocol updates.
Conferences involving multidisciplinary teams outside surgery were significantly more likely to be perceived as effective by pediatric surgeons compared to single-specialty formats (55% vs 47%; P = 0.005).
Implementation of structured multidisciplinary reviews increased participant identification of avoidable complications from 23% to 54% of cases and supported quality improvements such as raising a hospital cardiac rating from 1 star to 3 stars.

Study Design

Type

Systematic Review

Structured PICO

Do perioperative team-based morbidity and mortality conferences (TBMMs) improve patient safety, clinician education, and quality improvement outcomes compared with single-discipline conferences or pre-implementation baselines in the perioperative setting?

P

Population

7 studies (6 single-center implementation reports and 1 national survey of 353 pediatric surgeons) evaluating perioperative team-based morbidity and mortality conferences across the United States, France, and Morocco.

I

Intervention

Perioperative team-based morbidity and mortality conferences (TBMMs) involving multiple specialties (e.g., surgery, anesthesiology, cardiology) or professions (e.g., physicians, nurses), incorporating structured pre-conference case selection and analysis, standardized presentation formats with formal moderators during the conference, and post-conference action plans and quality improvement follow-up.

C

Comparator

None in most studies; pre-implementation baseline or single-discipline morbidity and mortality conferences where comparisons were made.

O

Outcome

Educational outcomes, identification of adverse event causes and contributing factors (patient safety), and quality improvement process measures.safety

This systematic review identifies core structural elements before, during, and after perioperative team-based morbidity and mortality conferences—such as structured case investigation, standardized blame-free presentations with trained moderators, and closed-loop follow-up—that support improved adverse event recognition, clinician education, and system-level quality improvement.

Limitations

The 6 studies describing TBMM implementation were all single-center studies using descriptive or unadjusted pre-post designs without controls.
Heterogeneous outcomes prevented conducting a meta-analysis.
Moderate risk of bias (scores of 4 to 6 stars out of 9 on the Newcastle-Ottawa Quality Assessment Scale).
Potential publication bias, as unsuccessful TBMMs are less likely to be reported, and exclusion of gray literature.
The 6 studies describing TBMM implementation were all single-center studies, either describing programs or using unadjusted preimplementation and postimplementation trial designs.
None of the studies included controls for comparing patient groups or quality improvement projects.
Studies had a moderate risk of bias, scoring 4 or 6 stars out of 9 on the Newcastle-Ottawa Quality Assessment Scale.
Potential publication bias making unsuccessful TBMMs less likely to be reported, and restriction of the search to traditional peer-reviewed medical literature (excluding gray literature).
Heterogeneity of educational, safety, and quality improvement outcomes precluded a meta-analysis.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Team-based morbidity and mortality conferences may enhance perioperative education and complication recognition; leaves open optimal standardization for consistent quality gains.

Abstract

Objective: This systematic review aimed to identify key elements of perioperative team-based morbidity and mortality conferences (TBMMs) and their impact on patient safety, education, and quality improvement outcomes. Background: Patient safety in the perioperative period is influenced by system, team, and individual behaviors. However, despite this recognition, single-discipline morbidity and mortality conferences remain a mainstay of educational and quality improvement efforts. Methods: A structured search was conducted in MEDLINE Complete, Embase, Web of Science, ClinicalTrials.gov, Cochrane CENTRAL, and ProQuest Dissertations and Theses Global in July 2022. Search results were screened, and the articles meeting inclusion criteria were abstracted. Results: Seven studies were identified. Key TBMM elements were identified, including activities done before the conference-case selection and case investigation; during the conference-standardized presentation formats and formal moderators; and after the conference-follow-up emails and quality improvement projects. The impacts of TBMMs on educational, safety, and quality improvement outcomes were heterogeneous, and no meta-analysis could be conducted; however, improvement was typically shown in each of these domains where comparisons were made. Conclusions: Recommendations for key TBMM elements can be drawn from the reports of successful perioperative TBMMs. Possible benefits of structured TBMMs over single-discipline conferences were identified for further exploration, including opportunities for rich educational contributions for trainees, improved patient safety, and the potential for system-wide quality improvement. Design and implementation of TBMM should address meticulous preparation of cases, standardized presentation format, and effective facilitation to increase the likelihood of realizing the potential benefits.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Samost-Williams et al. (2023) conducted a systematic review in Perioperative morbidity and mortality across general, cardiac, pediatric, and surgical oncology patients. Perioperative team-based morbidity and mortality conferences (TBMMs) vs. Single-discipline morbidity and mortality conferences or pre-implementation baseline was evaluated on Impact on patient safety, educational, and quality improvement outcomes. Perioperative team-based morbidity and mortality conferences across 7 studies showed heterogeneous improvements in education, recognition of avoidable complications (54% vs 23%, P<0.05), and quality improvement.

synapsesocial.com/papers/6a7316d18c926c39f5c22def https://doi.org/10.1097/as9.0000000000000321

View Full Paper

Ask AI

Bookmark

Share

Perioperative Team-Based Morbidity and Mortality Conferences: A Systematic Review of the Literature

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Perioperative Team-Based Morbidity and Mortality Conferences: A Systematic Review of the Literature

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading