Evaluation of the Implementation of a Quality Improvement Program Through Morbidity and Mortality Reviews

Evaluation of the Implementation of a Quality Improvement Program Through Morbidity and Mortality Reviews in a Developing Country

Morbidity and mortality reviews represent an opportunity to discuss adverse events and healthcare issues. Aim is to report the first experience of implementing a standardized procedure of morbidity and mortality reviews, and assess its impact on quality improvement.

Study Overview

• Status: Completed
• Conditions: Quality Improvement

Detailed Description

From July 2019 to December 2019, members of the surgical and intensive care unit departments designed and implemented a regular procedure of morbidity and mortality reviews. Cases of severe postoperative complications after curative resection for digestive cancer were selected to be presented by a surgical resident and discussed in an interdisciplinary conference following a standardized presentation based on an analysis tool adapted from the ALARM framework. Process was assessed by the number of morbidity and mortality reviews held, number and type of recommendations issued and implemented.

Among 13 serious complications during the study period, 10 were discussed. The "Tasks" category was activated in 90% of the cases where lack or misuse of protocols was identified in 90% of the events discussed. Test results availability or accuracy were incarnated in 30% of cases. Poor communication was a contributing factor in 60% of the cases. Written medical records were defective in 40% of the cases. From 16 recommendations for improvement emitted, 87.5% (14/16) were translated into projects and successfully implemented.

Thus, a standardized and regular procedure of morbidity and mortality reviews in a tertiary care facility in a developing country allowed a significant improvement in patient care through quality initiatives implementation. Morbidity and mortality reviews might be a strong tool for the improvement of surgical care particularly for low-mid income countries

• Study Type: Observational
• Enrollment (Actual): 13

Contacts and Locations

Study Locations

• Morocco
  • Rabat, Morocco, 10090
    • National Institute of Oncology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients who underwent a curative surgical procedure for a digestive cancer in our department during the study period and who presented severe adverse events in 90 post operative day

Description

Inclusion Criteria:

• severe adverse events defined as postoperative morbidity > 3a according to the Clavien Dindo grading system
• within the first 90 postoperative days of surgery
• Cases discussed in a morbidity and mortality review

Exclusion Criteria:

• Cases not discussed in a morbidity mortality review

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Process assessment	evaluation of the number of MMRs, numbers and categories of identified contributing factors, number and types of recommendations and number and types of implemented recommendations.	one year

Collaborators and Investigators

• Sponsor: Moroccan Society of Surgery
• Investigators: Principal Investigator: Oumayma Lahnaoui, MD, National Institute of Oncology; Study Director: Anass Majbar, MD, National Institute of Oncology

Publications and helpful links

General Publications

• Houssaini K, Lahnaoui O, Souadka A, Majbar MA, Ghanam A, El Ahmadi B, Belkhadir Z, Amrani L, Mohsine R, Benkabbou A. Contributing factors to severe complications after liver resection: an aggregate root cause analysis in 105 consecutive patients. Patient Saf Surg. 2020 Sep 29;14:36. doi: 10.1186/s13037-020-00261-7. eCollection 2020. Erratum In: Patient Saf Surg. 2020 Nov 12;14(1):41.
• Souadka A, Benkabbou A, Al Ahmadi B, Boutayeb S, Majbar MA. Preparing African anticancer centres in the COVID-19 outbreak. Lancet Oncol. 2020 May;21(5):e237. doi: 10.1016/S1470-2045(20)30216-3. Epub 2020 Apr 3. No abstract available.
• Souadka A, Majbar MA, Essangri H, Amrani L, Benkabbou A, Mohsine R, Souadka A. Functional outcomes over time following perineal pseudocontinent colostomy reconstruction after abdominoperineal resection for ultralow rectal adenocarcinoma. J Surg Oncol. 2020 Jun 20. doi: 10.1002/jso.26074. Online ahead of print.
• Majbar MA, Courtot L, Dahbi-Skali L, Rafik A, Jouppe PO, Moussata D, Benkabbou A, Mohsine R, Ouaissi M, Souadka A. Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A "real life" study in a developing country. J Visc Surg. 2022 Jun;159(3):187-193. doi: 10.1016/j.jviscsurg.2021.04.004. Epub 2021 Jun 4.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2019
• Primary Completion (ACTUAL): December 31, 2019
• Study Completion (ACTUAL): January 31, 2020

Study Registration Dates

• First Submitted: March 9, 2022
• First Submitted That Met QC Criteria: March 9, 2022
• First Posted (ACTUAL): March 18, 2022

Study Record Updates

• Last Update Posted (ACTUAL): April 5, 2022
• Last Update Submitted That Met QC Criteria: March 25, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Keywords: implementation; patient safety; quality improvement; morbidity and mortality reviews
• Other Study ID Numbers: RMM_INO

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No