P0600 - M&M 2.0: How to teach an old dog new tricks

Background: Errors in medicine are common and often preventable. Their impact on patient outcomes and handicap on delivering high value care have been recognized as an important metric for health systems evaluation. Morbidity and Mortality Conference (MMC), although a ubiquitous requirement of residency training and beyond, often fails to produce a consistent vehicle for systems-based change. At Albany Medical Center, after a needs assessment survey of senior residents and faculty, we found that only 9.5% of MMC’s produced sustainable or meaningful systems-based changes. In addition, only 29% of trainees felt comfortable presenting at MMC without a sense of intimidation. Fifty percent of trainees reported proficiency in identifying appropriate cases for MMC and only 31% of residents reviewed cases with a mentor to focus their presentation on MMC goals and objectives.

Methodology: Our objectives were to (1) improve development of systems-based solutions, to (2) reduce the sense of intimidation presenting at MMC, improve proficiency in preparing for MMC by being able to (3) identify appropriate cases and (4) reviewing with mentors (MMC Champions) by 25% in each of these 4 categories after 6 month intervals of PDSA cycles.

Our interventions included: utilization of a standard template to facilitate predictable discussion points, creation and assignment of an MMC Champion (faculty or Chief Resident mentor) to each case responsible for its review prior to presentation, itemizing discrete and limited responsibilities for resident presentation to reduce perceptions of intimidation, formal coaching on identifying valuable cases for presentation, and establishing a structure for implementing systems-based change after conference. In anticipation of increased time needed to prepare each case, we decreased the number of cases presented at each conference and the number of conferences per year. Data was collected with pre and post-intervention surveys of senior residents at 6 month intervals.

Discussion: After 6 and 12 months of interventions, we saw (1) concrete solutions to systems-based errors or practice pathways reported in 63% and 82% of cases, respectively. Additionally, (2) 35% and 29% reported no sense of intimidation with MMC presentations along with (3) 85% and 88% of residents reporting proficiency in identifying appropriate cases, respectively. Interventions also resulted in (4) MMC Champion involvement in 70% and 88% of presentations at 6 and 12 months, respectively.

Conclusions: With our improved structure for MMC, we provided a new and efficient pathway for residents and faculty to contribute to systems-based quality improvement. Clear identification of MMC mentors also drastically improved resident identification of cases. Although we did not see a sustained decrease in the sense of intimidation, as we continue to establish a new precedent of preparing for MMC within the context of quality improvement, residents will feel more comfortable presenting in a safe environment.