Literature DB >> 30051034

Emergency Medicine Morbidity and Mortality Conference and Culture of Safety: The Resident Perspective.

Kathleen Wittels1, Emily Aaronson1,2, Richard Dwyer1, Eric Nadel1,2, Fiona Gallahue3, Christopher Fee4, Robert Tubbs5, Jeremiah Schuur1.   

Abstract

OBJECTIVE: Morbidity and mortality conference (M&M) is common in emergency medicine (EM) and an Accreditation Council for Graduate Medical Education (ACGME) requirement. We aimed to characterize the prevalence of elements of EM M&M conferences that foster a strong culture of safety.
METHODS: Emergency medicine residents at 33 programs across the United States were surveyed using questions adapted from a previously tested survey of EM program directors and the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety Survey.
RESULTS: The survey response rate was 80.3% (1,002/1,248). A total of 60.3% (601/997) of residents had not submitted a case of theirs to M&M in the past year. A total of 7.6% (73/954) reported that issues raised at M&M always led to change while 88.3% (842/954) reported that they sometimes did and 4.1% (39/954) reported that they never did. A total of 56.2% (536/954) responded that changes made due to M&M were reported back to the residents. Of residents who had cases presented at M&M, 24.2% (130/538) responded that there was regular debriefing, 65.2% (351/538) responded that there was not, and 10.6% (57/578) were unsure. A total of 10.2% (101/988) of respondents agreed that M&M was punitive, 17.4% were neutral (172/988), and 72.4% (715/988) disagreed. A total of 18.0% (178/987) of residents agreed that they felt pressure to order unnecessary tests because of M&M, 22.3% (220/987) were neutral, and 59.6% (589/987) disagreed. A total of 87.4% (862/986) felt that M&M was a valuable educational didactic session, and 78.3% (766/978) believed that M&M contributes to a culture of safety in their institution.
CONCLUSIONS: While most residents believe that M&M is a valuable didactic session and contributes to institutional culture of safety, there are opportunities to improve by communicating changes made in response to M&M, debriefing residents who have had cases presented, and taking steps to make M&M not feel punitive to some residents.

Entities:  

Year:  2017        PMID: 30051034      PMCID: PMC6001737          DOI: 10.1002/aet2.10033

Source DB:  PubMed          Journal:  AEM Educ Train        ISSN: 2472-5390


  13 in total

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2.  The morbidity and mortality conference: the delicate nature of learning from error.

Authors:  Jay D Orlander; Thomas W Barber; B Graeme Fincke
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4.  Morbidity and Mortality conference in Emergency Medicine.

Authors:  Todd A Seigel; Daniel C McGillicuddy; Adam Z Barkin; Carlo L Rosen
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5.  American Board of Emergency Medicine report on residency training information (2014-2015).

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Journal:  Ann Emerg Med       Date:  2015-05       Impact factor: 5.721

6.  Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.

Authors:  Terri P McVeigh; Peadar S Waters; Ruth Murphy; Gerrard T O'Donoghue; Ray McLaughlin; Michael J Kerin
Journal:  J Am Coll Surg       Date:  2012-11-02       Impact factor: 6.113

Review 7.  What is patient safety culture? A review of the literature.

Authors:  Christine E Sammer; Kristine Lykens; Karan P Singh; Douglas A Mains; Nuha A Lackan
Journal:  J Nurs Scholarsh       Date:  2010-06       Impact factor: 3.176

8.  Do house officers learn from their mistakes?

Authors:  A W Wu; S Folkman; S J McPhee; B Lo
Journal:  JAMA       Date:  1991-04-24       Impact factor: 56.272

9.  Attitudes and barriers to incident reporting: a collaborative hospital study.

Authors:  S M Evans; J G Berry; B J Smith; A Esterman; P Selim; J O'Shaughnessy; M DeWit
Journal:  Qual Saf Health Care       Date:  2006-02

10.  Evaluation of an anonymous system to report medical errors in pediatric inpatients.

Authors:  James A Taylor; Dena Brownstein; Eileen J Klein; Thomas P Strandjord
Journal:  J Hosp Med       Date:  2007-07       Impact factor: 2.960

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  6 in total

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Authors:  N Skowron; P Wilke; M Bernhard; U Hegerl; A Gries
Journal:  Anaesthesist       Date:  2019-11       Impact factor: 1.041

2.  Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey.

Authors:  Joseph A Grubenhoff; Sonja I Ziniel; Christina L Cifra; Geeta Singhal; Richard E McClead; Hardeep Singh
Journal:  Pediatr Qual Saf       Date:  2020-02-27

3.  The Impact of Anonymity in Emergency Medicine Morbidity and Mortality Conferences: Findings from a National Survey of Resident Physicians.

Authors:  Emily L Aaronson; Kathleen Wittels; Richard Dwyer; Eric Nadel; Fiona Gallahue; Olesya Baker; Christopher Fee; Robert Tubbs; Jeremiah Schuur
Journal:  West J Emerg Med       Date:  2019-12-19

Review 4.  Evolving from Morbidity and Mortality to a Case-based Error Reduction Conference: Evidence-based Best Practices from the Council of Emergency Medicine Residency Directors.

Authors:  Yashwant Chathampally; Benjamin Cooper; David B Wood; Gregory Tudor; Michael Gottlieb
Journal:  West J Emerg Med       Date:  2020-10-06

5.  Emergency Medicine Morbidity and Mortality Conference and Culture of Safety: The Resident Perspective.

Authors:  Kathleen Wittels; Emily Aaronson; Richard Dwyer; Eric Nadel; Fiona Gallahue; Christopher Fee; Robert Tubbs; Jeremiah Schuur
Journal:  AEM Educ Train       Date:  2017-05-04

6.  Education as Culture: The Amazing and Awesome Case Conference.

Authors:  Eve Purdy; Rob Roseby; Manuela Brinkmann; Elizabeth Blackmore; Chris Meyer; Daniel Cabrera
Journal:  J Grad Med Educ       Date:  2021-02-13
  6 in total

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