Morbidity, Mortality, and Improvement Conferences Engage Residents in Systems‐Based Practice

1Vanderbill University, Nashville, TN
2Vanderbilt University, Nashville. TN
3Vanderbilt University, Nashville. TN
4vanderbilt University, Nashville, TN
5Vanderbilt University, Nashville, TN

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 161


An institutional requirement is lo conduct quarterly morbidity and mortality (M&M) conferences involving the internal medicine house staff. However, traditional MSM conferences often fail to address systems‐based factors or generate solutions to issues raised during discussion. An innovative morbidity, mortality, and improvement (MM&l) conference format is proposed as an alternative model To M&Ms.


The purpose was to implemenl a quarterly MMfil conference with Ihe internal medicine house staff. The goals of each conference are to present cases that introduce systems‐based issues, to engage residents in identifying factors that contributed to the outcome of each case, and to form a task force to address those issues. The resident task force subsequently works with quality improvement mentors to implement changes using plan‐do‐study‐act (PDSA) cycles.


The first MM&I conference involved a case that revealed several deficits in handover communication among different resident teams, including The primary team, cross‐cover, and a critical care Team. Using The framework of a fishbone diagram and Ihe assistance of a faculty facilitator, residents participated in an open discussion of factors pertinent to the handover process. At the end of the conference, several residents volunteered to join a task force that met monthly to improve the handover process. Facilitated by internal medicine faculty and patient safely experts, residents developed a specific aim, researched best practices for handover communication, conducted focus groups to identify how the current handover documentation template could be improved, and designed a new electronic handover tool. The group met with information technology leadership To create the new Tool, which was then piloted by a small number of interns during overnight call. Ongoing PDSA cycles have been in progress to refine the tool and incorporate it into the institution's electronic health record. Subsequent MM&I conferences have presented additional opportunities for syslems‐basec improvement of patient care, including appropriate utilization of the rapid response team and electronic notification of vital sign abnormalities; multidiscipli‐nary task forces are currently engaged in developing, testing, and implementing interventions To address these issues.


The MM&I conferences have been well received, and numerous residenls have joined the MM&I task forces. The process has enabled internal medicine house staff to meet the Accreditation Council of Graduate Medical Education requirements for practice‐based learning and improvement and systems‐based practice. Hospitalists serve as faculty facilitators and champions for specific projects. The curriculum has been successful in creating and implementing concrete solutions to systems‐based issues encountered in hospital practice.

Author Disclosure:

K. Cunningham, none: U. Whalen, none; M. Semler, none; S. Polancich, none; S. Kripalani, none

To cite this abstract:

Cunningham K, Whalen U, Semler M, Polancich S, KripalanL S. Morbidity, Mortality, and Improvement Conferences Engage Residents in Systems‐Based Practice. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 161. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed March 31, 2020.

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