Morbidity and Mortality

Morbidity and Mortality rounds date back from the early 1900s when an MGH surgeon Dr. Codman decided to review the end results for all his patients. He hoped by looking at how his patients did, he would gain insight to errors, mistakes, or areas of improvement for his practice. He actually lost privileges at the hospital when he suggested that surgeons be evaluated for their performance.

Now most hospitals have M&M rounds. These rounds, closed to the public, are a confidential internal quality review. I lead the last M&M for the intensive care unit. I pulled up all the data on deaths in the ICU in the last month and reviewed those cases. Were there things we could have improved? Were there things we should have done differently? I engaged the primary treatment physicians to understand their thinking and thought process. I solicited feedback from physicians who were not involved for their opinion. Then, I examined a few cases in detail, trying to understand if there are any processes or protocols that can be improved. I identified several key teaching points and areas where we could improve. It ended up being a very well attended conference, and I was pleased with the outcome.

In these M&M rounds, I don't find that any individual person is ever at fault; most often, the things we decide to change are system-level improvements. No one wants to hear that physicians are still working out the kinks. But I think it would be worse if we were so arrogant to think that we did everything perfectly. We don't. And we need to have a process for constant evaluation and improvement in order to take the best care of our patients that we can.