Educational quality improvement report: outcomes from a revised morbidity and mortality format that emphasised patient safety
Educational quality improvement report: outcomes from a revised morbidity and mortality format that emphasised patient safety
复制标题
DOI：
10.1136/qshc.2006.021139
复制
发表时间：
2007-12-01
影响因子：
--
通讯作者：
Hall, L. W.
中科院分区：
文献类型：
--
作者：
Bechtold, M. L.;Scott, S.;Hall, L. W.
问题：虽然发病率和死亡率会议（mmc）旨在通过仔细分析不良事件来促进高质量的护理，但关注个人行为或担心被指控可能会干扰对导致不良结果的系统问题的识别。设计：采用态度调查评估干预前后参与者对患者安全和会议重新设计的态度。对影响因素、建议的解决方案和有针对性的系统改进进行了列表，并记录了正在进行的进展。背景：密苏里大学哥伦比亚分校内科培训项目。参加者：上述住院医师计划的住院医师及研究员。教育目标：(1)区分责备/羞耻文化和患者安全文化，(2)确定导致不良结果的质量差距，(3)确定缩小差距的策略，(4)参与根本原因分析，展示审查不良事件并建议行动计划的能力。变革策略：一个跨学科团队修改了内科MMC，以强调更好地理解患者安全原则和基于系统的实践干预。对于分析的每个不良事件，确定了根本原因，然后讨论了可能预防未来此类事件的系统干预措施。改善的关键措施：(1)住院医师和研究员对患者安全的态度，通过20项5分顺序量表调查来衡量，(2)患者安全MMC （PSMMC）产生的系统改进，(3)PSMMC的出勤情况。改变的效果：临床结果：提出了121项系统改进建议，根据实现高影响变化的可能性，提出了39项建议。实施了23项改进，11项部分实施或正在进行中，5项因不切实际或冗余而放弃。教育成果：58名住院医师和研究员完成了会议形式修改前后的问卷调查。20 .调查项目显示有重大变化，其中四个变化发生在期望的方向上。剩下的14个回答中有11个朝着预期的方向变化。MMC的平均出席人数从41 +/- 8人增加到50 +/- 10人（p < 0.03）。经验教训：新的PSMMC在不牺牲出勤率或居民或研究员的态度的情况下，在病人护理质量方面进行了多项改进。新的PSMMC促进了参与者在安全和培育环境中提高患者护理质量的机会。
Problem: Although morbidity and mortality conferences ( MMCs) are meant to promote quality care through careful analysis of adverse events, focus on individual actions or the fear of incrimination may interfere with identification of system issues contributing to the adverse outcomes. Design: Participant attitudes before and after the intervention towards patient safety and conference redesign were assessed using an attitudinal survey. A list of contributing factors, recommended solutions and targeted system improvements was maintained with ongoing progress recorded. Setting: Department of Internal Medicine training programme at University of Missouri - Columbia. Participants: Residents and fellows from the above residency programme. Educational objectives: ( 1) Distinguish between culture of blame/ shame and patient safety culture, ( 2) identify gaps in quality contributing to adverse outcomes ( 3) identify strategies to close gaps and ( 4) participate in root cause analysis, demonstrating an ability to review an adverse event and recommend an action plan. Strategies for change: An interdisciplinary team modified the internal medicine MMC to emphasise a better understanding of patient safety principles and system- based practice interventions. For each adverse event analysed, root causes were identified, followed by discussion of system interventions that might prevent future such events. Key measures for improvement: ( 1) Attitudes of residents and fellows regarding patient safety, as measured on a 20- item, five- point ordinal scale survey, ( 2) system improvements generated from the patient safety MMC ( PSMMC) and ( 3) attendance at PSMMC. Effects of change: Clinical outcomes: 121 system improvement recommendations were made and 39 were pursued on the basis of likelihood of achieving high impact changes. 23 improvements were implemented, 11 were partially implemented or in progress, and 5 were abandoned due to impracticality or redundancy. Educational outcomes: 58 residents and fellows completed surveys before and after modification of conference format. 6/ 20 survey items showed substantial change with four of these changes occurring in the desired direction. Eleven of the remaining 14 responses changed in the desired direction. Average MMC attendance increased from 41 +/- 8 to 50 +/- 10 participants ( p < 0.03). Lessons learnt: The new PSMMC initiated multiple improvements in the quality of patient care without sacrificing attendance or attitudes of the residents or fellows. The new PSMMC promotes opportunities for participants to improve quality of patient care in a safe and nurturing environment.