Morbidity & Mortality Conference

M&M conferences are a critical part of the resident’s learning process and their development as practitioners who prioritize care quality and patient safety. Through these conferences, residents, fellows and faculty present on and discuss cases of unexpected morbidity or mortality to identify opportunities to improve performance and clinical outcomes.

Following is information for participation in and presentation at M&M conferences for general surgery resident.

Resources

Ground Rules

All cases involving complications, deaths, adverse or near-miss events must be logged each week in the M&M reporting system. Important near-miss events should also be logged. If there are no complications, deaths, adverse or near-miss events, the person responsible for logging the cases for a service must indicate ”no cases” in the M&M system. If no cases are entered and you fail to log in and select “no cases,” then you will be selected to discuss cases without notice.

The person responsible for logging required cases is the senior most resident on the service.

Cases for the prior Thursday through Wednesday evening must be logged by 12 p.m. on Thursday each week.

Events can also be reported anonymously. These events will be forwarded to the M&M moderator for consideration.

You will be notified by Thursday afternoon by mass email regarding cases that have been selected for presentation.

You will be notified if additional data are needed for the Comparative Data slide. Potential data sources include: 

• Northwestern Online Surgical Quality Improvement (NOSQI) system
  American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP)
• University Health Consortium (UHC)
• NMH administrative data
• Surgical Care Improvement Program
• NMH Cancer Registry

Use the PowerPoint Template (available at the top of this page). Please do not add slides unless they are for relevant images. You can delete slides as needed (i.e., "Literature Review" or "Comparative Data").

Submit your PowerPoint before the meeting using the email address at the top of this page. In addition, always bring the presentation on a flash drive or similar storage in case there are email problems.

All residents and attendings are required to attend the M&M Conference. Refer to the resident Attendance Policy for service-specific conference requirements.

Presentations should be less than five minutes.

There should be no questions from the audience until the presentation is completed. Only the moderator may ask questions to clarify the presentation.

Words of Wisdom

Slides and presentations should be reviewed by the attending of record.

Presentations should be practiced by verbally running through the presentation and timing it. Uninterrupted presentations should take five minutes or less.

The verbal portion should help in focusing the audience's attention on the most important points and provide clarification of particular details.

The presentation is essentially a creation of a story and a logical argument, so it should flow and make sense.

Although the complication is the central focus of the oral presentation and slides, the presenting residents are expected to be familiar with the entirety of the case. This includes having a thorough understanding of the management options and outcomes for those options (whether surgical or medical) of the underlying disease process(es) and the complication. This will generally require reading in addition to a discussion with the attending. Variations from standard management and the reasons for them should be discussed with the attendings prior to presentation so that decision making for the case is clearly understood by the presenter.

Clavien Error Grade Definitions

• Grade I: Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics, electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside
• Grade II: Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.
• Grade III: Requiring surgical, endoscopic or radiological intervention (with or without general anesthesia).
• Grade IV: Life-threatening complication requiring ICU management (includes single or multi-system organ failure) or complication resulting in permanent disability.
• Grade V: Death of a patient