|
Morbidity & mortality meetings
Morbidity and mortality (M&M) meetings should be an integral part of the provision of good medical care. It was therefore of great concern that 40% of hospitals within this study reported that the critical care service does not have regular M&M meetings (Table 7a). Where M&M meetings did occur, it is clear from the data in Table 7b that the main input into these meetings was by consultants in anaesthesia and intensive care medicine. Whilst other staff members did attend it was with a much lower frequency and undermined the principle of multidisciplinary case review. We have earlier shown that there are concerns with the management of medical patients prior to admission to critical care. The low participation of referring physicians in M&M meetings is a missed chance to address some of these issues.
| Table 7a. Regular morbidity and mortality (M&M) meetings in ICU |
| Mortality meetings |
Total |
(%) |
| Yes |
125 |
(60) |
| No |
83 |
(40) |
| Sub-total |
208 |
|
| Not answered |
3 |
|
| Total |
211 |
|
| Table 7b. Attendance of morbidity and mortality (M&M) meetings in ICU |
| Which health professionals attend (Answers may be multiple) |
Total n = 202 |
| Anaesthetists |
94 |
| Intensive care consultants |
114 |
| ICU trainees |
96 |
| Microbiologists/infection control |
20 |
| Nurses |
76 |
| Nutrition/dietetic staff |
15 |
| Operating department practitioners |
5 |
| Pathologists |
2 |
| Pharmacists |
17 |
| Physiotherapists |
28 |
| Referring physicians |
14 |
| Referring surgeons |
19 |
| Other |
13 |
The ICU consultant who completed the ICU questionnaire was asked whether each patient's management would be reviewed at an M&M meeting. This data is shown in Table 8. There were only 168 cases where it was stated that the patient's management would be reviewed. It should be remembered that there were 560 deaths within this study (see Data overview chapter). Whilst there were a large number of cases where the answer to the question of review was unknown or not answered there is the possibility that a number of deaths were not considered at mortality and morbidity meetings. Tables 9a and 9b show that consultant physicians were informed in less than 27% of cases where a patient originally under their care was to be reviewed at an M&M meeting and even with notification,
the attendance of a consultant physician was low. Many of the problems in the care of acute medical patients, which have been highlighted in the literature and in this study, are rooted in process issues
that are ideally suited to be broached in the forum of M&M meetings. The low level of M&M meetings and participation from medicine is therefore very worrying. In addition, the data suggests that the guidance issued by the Federation of the Royal Colleges of Physicians of the UK is not being complied with 9.
This document states that '"all deaths within 24 hours of admission and other unexpected deaths
should be promptly reviewed in a multidisciplinary forum".
Table 8. Review of patients' management at morbidity and mortality (M&M) meetings
(answers from ICU consultants) |
| Patient's management to be reviewed at M&M meeting? |
Total |
(%) |
| Yes |
168 |
(20) |
| No |
686 |
(80) |
| Sub-total |
854 |
|
| Unknown |
178 |
|
| Not answered |
564 |
|
| Total |
1,596 |
|
| Table 9a. Consultant physician informed of patient’s review at morbidity and mortality (M&M) meetings |
| Physician informed? |
Total |
(%) |
| Yes |
21 |
(27) |
| No |
57 |
(73) |
| Sub-total |
78 |
|
| Unknown |
29 |
|
| Not answered |
61 |
|
| Total |
168 |
|
| Table 9b. Consulting physician attendance of patient’s review at morbidity and mortality (M&M) meetings |
| Physician present? |
Total |
(%) |
| Yes |
6 |
(33) |
| No |
12 |
(67) |
| Sub-total |
18 |
|
| Unknown |
2 |
|
| Not answered |
1 |
|
| Total |
21 |
|
Back to top
|