Gabriela Zavala Wong1,2,3, Manuel J Rodriguez Castro4, Eduardo Huaman Egoavil5, Roberto Valderrama5, Charles N Mock6, Juan J Herrera-Matta7, Gianni Aragon8,9, Ryan Peterson10, Ying Jin10, Lacey N LaGrone11. 1. Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru. gabriela.zavala.w@upch.pe. 2. Postdoc, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA, USA. gabriela.zavala.w@upch.pe. 3. Research Division, Sociedad de Cirujanos Generales del Peru, Av. Arenales 2049, Lima, Peru. gabriela.zavala.w@upch.pe. 4. Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru. 5. Department of Surgery, Hospital Nacional Guillermo Almenara, Jr. Garcia Naranjo 840, Lima, Peru. 6. Department of Global Health, University of Washington, 1400 NE Campus Parkway, Seattle, WA, USA. 7. Department of Surgery, Hospital de Policia, Av. Brasil 26, Lima, Peru. 8. Department of Surgery, Clinica Limatambo, Av. Republica de Panama 3606, Lima, Peru. 9. Department of Surgery, Clinica San Gabriel, Av. la Marina 2955, Lima, Peru. 10. Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th, Aurora, CO, USA. 11. Department of Surgery, University of Colorado, 2500 Rocky Mountain Ave, Loveland, CO, USA.
Abstract
BACKGROUND: Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them. METHODS: The present study aims to gather general surgeons representing most of Peru's urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices. RESULTS: A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described "improve the system" as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p < 0.001). CONCLUSION: We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of "system improvement" as the goal of M&M conferences.
BACKGROUND: Morbidity and Mortality (M&M) conferences allow clinicians to review adverse events and identify areas for improvement. There are few reports of structured M&M conferences in low- and middle-income countries and no report of collaborative efforts to standardize them. METHODS: The present study aims to gather general surgeons representing most of Peru's urban surgical care and, in collaboration, with trauma quality improvement experts develop a M&M conferences toolkit with the expectation that its diffusion impacts their reported clinical practice. Fourteen general surgeons developed a toolkit as part of a working group under the auspices of the Peruvian General Surgery Society. After three years, we conducted an anonymous written questionnaire to follow-up previous observations of quality improvement practices. RESULTS: A four-component toolkit was developed: Toolkit component #1: Conference logistics and case selection; Toolkit component #2: Documenting form; Toolkit component #3: Presentation template; and Toolkit component #4: Code of conduct. The toolkit was disseminated to 10 hospitals in 2016. Its effectiveness was evaluated by comparing the results of surveys on quality improvement practices conducted in 2016, before toolkit dissemination (101 respondents) and 2019 (105 respondents). Lower attendance was reported by surgeons in 2019. However, in 2019, participants more frequently described "improve the system" as the perceived objective of M&M conferences (70.5% vs. 38.6% in 2016; p < 0.001). CONCLUSION: We established a toolkit for the national dissemination of a standardized M&M conference. Three years following the initial assessment in Peru, we found similar practice patterns except for increased reporting of "system improvement" as the goal of M&M conferences.