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The morbidity and mortality meeting: time for a different approach?
  1. James Fraser
  1. Correspondence to Dr James Fraser, Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK; james.fraser{at}UHBristol.nhs.uk

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Introduction

Although morbidity and mortality (M&M) meetings are regarded as the cornerstone of hospital governance process,1 there is little evidence that they are effective in improving patient outcomes.2 ,3 Formats vary widely, approaches to categorising error inconsistent4 ,5 and few meetings adopt accepted models for incident analysis.6 Many errors are not reviewed, and the key protagonists often not present when a case is being discussed. While a standardised approach may engage the healthcare team in quality improvement initiatives, such formats have not been shown to impact on specific patient outcomes.7 Furthermore, M&M meetings fail to engage affected families. This lack of transparency in the context of the Francis report is at odds with our duty of candour to patients when things go wrong.8 There is, therefore, a need to re-evaluate how we should best scrutinise morbidity and mortality to bring about tangible improvements in patient care.9

The initial challenge is one of definition. The term ‘mortality’ is universally understood and describes a sentinel event that is easily recorded. However, professionals interpret ‘morbidity’ in a variety of ways, which partly explains why M&M meetings often fail to assess non-lethal patient outcomes in a systematic fashion. For the purposes of this article, I have taken ‘morbidity’ to encompass two situations: medical error defined as the failure of a planned action to be completed as intended, and adverse events as unintended patient harm resulting from either healthcare intervention or omission. Adverse events may occur due to medical error, but are often the unavoidable consequence of medical treatment, that may or may not be predictable (figure 1).10

Figure 1

Schema illustrating medical error and adverse events in the context of treatment, disease and injury.

In this paper, I will suggest that the investigation of medical error, …

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