1
|
Jeffs E, Newall F, Delany C, Kinney S. Goals of Morbidity and Mortality meetings in paediatric acute care. A qualitative case study. J Child Health Care 2024:13674935241249597. [PMID: 38831718 DOI: 10.1177/13674935241249597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Morbidity and Mortality meetings are conducted in varied clinical contexts including paediatrics. Widely cited as an educational or quality improvement tool, the reality is more complex. In this qualitative study, the aim was to explore the perceived goals of the paediatric acute care Morbidity and Morbidity meeting. This study used semi-structured interviews and observation within a qualitative case study methodology. Data were collected in a large paediatric quaternary hospital. Analysis generated themes related to meeting observations and the participant's interpretation of meeting goals. A total of 44 interviews were conducted with 14 nurses, 29 doctors, and 1 allied health professional. Thirty-two meetings in six clinical departments were observed. Two themes were developed: complex and nuanced goals; and tensions and contest between and within goals. Meeting goals to evaluate care, learn, support, adhere, and change and respond were sometimes in competition and had varied interpretations. Morbidity and Mortality meetings in this setting are valued and occupy a complex role which reaches beyond identification of measurable patient safety interventions. Understanding goals more fully can lead to optimised conduct and meaningful measurement of efficacy. The strength in these meetings may be the way they promote an embedded safety culture, and an informed and skilled workforce.
Collapse
Affiliation(s)
- Emma Jeffs
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
- The Women's and Children's Hospital Adelaide, Adelaide, SA, Australia
| | - Fiona Newall
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Clare Delany
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Sharon Kinney
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
2
|
Jeffs EL, Delany C, Newall F, Kinney S. Goals of the Morbidity and Mortality meeting in acute care: A scoping review. Aust Crit Care 2024; 37:185-192. [PMID: 38016842 DOI: 10.1016/j.aucc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe what is known about understandings of the goals of the Morbidity and Mortality meeting. REVIEW METHODS USED The study utilised scoping review methodology. DATA SOURCES Papers in English presenting empirical data published in academic journals with Morbidity and Mortality meetings as the central concept of study. Included papers presented data about the perception of stakeholders about goals of the Morbidity and Mortality meeting. Medline, Embase, and CINAHL databases were search conducted from earliest record - October 20th 2021. A manual search of the reference lists of all included papers identified further eligible papers. REVIEW METHODS Data about the location, participant type, and methods/ methodology were extracted and entered onto a database. Content analysis of the results and discussion sections of qualitative papers yielded broad categories of meeting goal. This provided a framework for the organisation of the quantitative findings, which were subsequently extracted and charted under these categories. RESULTS Twenty-five papers were included in the review, and six main categories were identified in the qualitative synthesis of findings. These included meeting goals related to quality and safety, education, legal and reputational risk management, professional culture, family/caregivers, and peer support. CONCLUSIONS There are heterogeneous understandings of key terminologies used to describe Morbidity and Mortality meeting goals, particularly evident within understandings of educational and quality and safety meeting goals. This paper defines and unravels this complexity in a way that researchers and clinicians can define, compare and evaluate their own department's meeting goals.
Collapse
Affiliation(s)
- Emma Louise Jeffs
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Clare Delany
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Fiona Newall
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Sharon Kinney
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
| |
Collapse
|
3
|
O'Reilly GM, Mathew J, Roy N, Gupta A, Joshipura M, Sharma N, Mitra B, Cameron PA, Fahey M, Howard T, Kumar V, Jarwani B, Soni KD, Thakor A, Dharap S, Patel P, Jhakal A, Farrow NC, Misra MC, Gruen RL, Fitzgerald MC. A checklist for trauma quality improvement meetings: A process improvement study. Injury 2019; 50:1599-1604. [PMID: 31040028 DOI: 10.1016/j.injury.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/22/2019] [Accepted: 04/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI) program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. METHODS This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO) TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. RESULTS There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007) and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4-9.4, p = 0.004) and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001) and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001). CONCLUSION This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.
Collapse
Affiliation(s)
- G M O'Reilly
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - J Mathew
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
| | - N Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Govt of India), Mumbai, India
| | - A Gupta
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - M Joshipura
- Academy of Traumatology (India), Ahmedabad, India
| | - N Sharma
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - B Mitra
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P A Cameron
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M Fahey
- Central Clinical School, Monash University, Melbourne, Australia; Tasmanian Health Service, Australia
| | - T Howard
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - V Kumar
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - B Jarwani
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - K D Soni
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - A Thakor
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - S Dharap
- Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - P Patel
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - A Jhakal
- Emergency Department, J.P.N.A. Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - N C Farrow
- Central Clinical School, Monash University, Melbourne, Australia; Safer Care Victoria, Melbourne, Australia
| | - M C Misra
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - R L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - M C Fitzgerald
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
| |
Collapse
|