Despite their long history, morbidity and mortality conferences (MMC) lack standardization and have not been shown to change behavior or improve outcomes. Our trauma center developed a database to record events discussed at acute care surgery MMC with the aim of improving the integration of MMC for education and quality improvement.

From May 2020 to November 2022, surgical trainees documented patient demographics, procedures performed, and details of adverse outcomes in a REDCap database. Using the institutionally developed Quality of Care Score (QCS) to standardize event reporting, trainees scored each event before MMC and consensus QCS was assigned after conference. We describe events presented at MMC and compare trainee to consensus scores.

We included data from 679 patients who experienced 916 reported events. Sixty-five percent of the cohort was admitted for trauma. Exploratory laparotomy (31%) and incision and soft tissue debridement (15%) were the most common procedures performed. Comparison of trainee versus consensus QCS revealed identical scores in 84% of cases. Consensus scores were lower than trainee scores 12% of the time and higher 3% of the time. While patient deaths comprised the majority of reported events over the study period (47%), they made up a decreasing proportion of overall events reported over time.

Through the development of a standardized reporting platform for patient events and use of a numeric grading system, our program facilitates rapid quantitative analysis of surgical adverse events using a platform that can be easily adapted to different practice environments and systems. Discordance between trainee and consensus QCS highlights opportunities for trainee education about standards of care and disease processes, and ongoing data collection facilitates rapid identification of quality concerns.

Surgical morbidity and mortality (M&M) conference is a cornerstone of surgical education and quality improvement. Despite its prominence, there are no widely established guidelines for the completion of M&M, nor training for surgical residents, who are frequently responsible for root cause analysis and case presentation.

Based on a recently published systematic review and expert focus groups with experienced surgeons, we developed a series of 10 recommendations and/or best practices for surgical M&M conference. A brief educational session was created to share the recommendations and best practices with resident presenters. Trained reviewers assessed the completion of aforementioned best practices before and after the educational session. Chi-square analysis was performed to evaluate changes after the educational initiative.

During the pre-education period, 49 M&M presentations were evaluated. Completion of best practice components ranged from 22.5% to 95.9%, with greater than 80% completion of 6 of 10 components. After the educational initiative, 45 additional presentations were evaluated. We observed a statistically significance increase in the number of presentations with a concise case presentation (baseline: 59.2%, posteducation: 88.9%, p = 0.002). Notable increases in completion were observed for 2 other components, although neither reached statistical significance: review of relevant, high-quality literature (baseline: 53.1%, posteducation: 66.7%, p = 0.116) and focused teaching point, with or without reference to literature (baseline: 63.3%, posteducation: 80.0%, p = 0.149). No clinically significant decreases were observed.

We used a mixed methods approach to design and evaluate an educational session to equip resident presenters with a series of evidence-based best practices for M&M conference. The findings demonstrate the potential positive impact of a brief, educational initiative on aspects of M&M conference at a single institution. The impact was ultimately limited, particularly in regard to scope and effect, which we postulate is due to the fact that the success of M&M conference is dependent on a range of factors. Nonetheless, to advance the effectiveness of M&M conference, we advocate for this initiative and related education for residents, given their principal role, as well as broader initiatives to increase the value of M&M conference.

The purpose of this study is two-fold: (1) Improve the quality of Morbidity and Mortality conferences by developing a standardized presentation template and assessment tool; (2) Assess the intervention impact by comparing pre- and post-intervention data.

A pre-post study was conducted at a tertiary care academic medical center between January 2022- January 2023. A standardized presentation template was created and a short assessment tool was developed to evaluate the quality of presentations on eight domains. We hypothesized that development of this template would significantly improve the quality of M&M conferences. Pre- and post-intervention data were compared using the Kruskal-Wallis test to evaluate for significant differences. Effect sizes for each domain were assessed by Cohen's d.

A total of 127 pre-intervention responses and 61 post-intervention responses were received over a six-month period. Statistically significant increases in post-intervention scores were noted in nearly all presentation domains, including clarity of case selection rationale, nature of the safety event, circumstances leading to the safety event, contributing factors, understanding of the safety event, and anticipated benefits to patient outcomes (p < 0.05). The effect sizes ranged from medium for rationale for case selection to small for the identification of corrective actions.

The introduction of a standardized, guided template improved the quality of Morbidity and Mortality presentations, with medium effect sizes and statistically significant increases in nearly all surveyed domains. A ceiling effect in the overall assessment score was noted as presentations prior to the intervention were rated highly. Standardization of case selection and presentations can promote alignment of the Quality Improvement Morbidity and Mortality workflow with broader-scope initiatives, departmentally and institutionally.

Emergency physicians are well-positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train future operational and academic leaders in telehealth.

The emotional impact of surgical complications on urologists is a significant yet historically under-addressed issue. Traditionally, surgeons have been expected to cope with complications and their psychological effects in silence, perpetuating a culture of perfectionism and 'silent suffering.' This has left many unprepared to handle the emotional toll of adverse events during their training and early careers. Recognizing the gap in structured education on this matter, there is a growing movement to openly address and educate on the emotional consequences of surgical complications. This article underscores the importance of such educational initiatives in the mid-career phase, proposing strategies to promote surgeon health, and psychological safety. It advocates for utilizing Morbidity and Mortality conferences as platforms for peer support, learning from 'near miss' events, and encourages at least annual department-wide discussions to raise awareness and normalize the emotional challenges faced by surgeons. Furthermore, it highlights the role of formal peer support programs, acceptance and commitment therapy, and resilience training as vital tools for promoting surgeon well-being. Resources from various organizations, including the American Urological Association and the American Medical Association, are now available to facilitate these critical conversations. By integrating these resources and encouraging a culture of openness and support, the article suggests that the surgical community can better manage the inevitable emotional ramifications of complications, thereby fostering resilience and reducing burnout among surgeons.

Administrative harm (AH), defined as the adverse consequences of administrative decisions within health care that impact work structure, processes, and programs, is pervasive in medicine, yet poorly understood and described.

To explore common AHs experienced by hospitalist clinicians and administrative leaders, understand the challenges that exist in identifying and measuring AH, and identify potential approaches to mitigate AH.

A qualitative study using a mixed-methods approach with a 12-question survey and semistructured virtual focus groups was held on June 13 and August 11, 2023. Rapid qualitative methods including templated summaries and matrix analysis were applied. The participants included 2 consortiums comprising hospitalist clinicians, researchers, administrative leaders, and members of a patient and family advisory council.

Quantitative data from the survey on specific aspects of experiences related to AH were collected. Focus groups were conducted using a semistructured focus group guide. Themes and subthemes were identified.

Forty-one individuals from 32 different organizations participated in the focus groups, with 32 participants (78%) responding to a brief survey. Survey participants included physicians (91%), administrative professionals (6%), an advanced practice clinician (3%), and those in leadership roles (44%), with participants able to select more than one role. Only 6% of participants were familiar with the term administrative harm to a great extent, 100% felt that collaboration between administrators and clinicians is crucial for reducing AH, and 81% had personally participated in a decision that led to AH to some degree. Three main themes were identified: (1) AH is pervasive and comes from all levels of leadership, and the phenomenon was felt to be widespread and arose from multiple sources within health care systems; (2) organizations lack mechanisms for identification, measurement, and feedback, and these challenges stem from a lack of psychological safety, workplace cultures, and ambiguity in who owns a decision; and (3) organizational pressures were recognized as contributors to AHs. Many ideas were proposed as solutions.

The findings of this study suggest that AH is widespread with wide-reaching impact, yet organizations do not have mechanisms to identify or address it.

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system. Patient complexity, illness severity, and the urgency in initiating proper treatment all contribute to decision-making errors. Clinician-related factors such as fatigue, cognitive overload, and inexperience further interfere with effective decision-making. Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error. This evidence-based review discusses ten common misconceptions regarding critical care decision-making. By understanding how practitioners make clinical decisions and examining how errors occur, strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.