Multidisciplinary 'M and M' More Beneficial

ROSEMONT, ILL. — Morbidity and mortality conferences can yield improvements more quickly than can any other quality or patient safety measure in a hospital, but only if all of the disciplines involved meet at the same table in a concerted effort to learn from errors and make lasting changes, according to Dr. Omar Lateef, director of the critical care safety program at Rush University Medical Center in Chicago.

“Currently, the 'M and M' model in most hospitals remains isolated by discipline, not geographic space,” with specialties such as medicine, surgery, cardiac surgery, and cardiology each holding separate conferences, Dr. Lateef said at the Joint Commission national conference on quality and patient safety.

This piecemeal approach of organizing conferences based on specialty fosters separatism, blocks communication, leaves other disciplines out of valuable learning experiences, and creates confusion that leads to errors, he said.

By way of example, he noted the patient with pneumonia who is placed in the cardiac intensive care unit and is given an aspirin before being given the appropriate initial antibiotic regimen, and the patient with a myocardial infarction who is placed in the medical ICU and is given antibiotics before receiving aspirin therapy.

These “cultural differences” based on specialty “aren't good when you're taking care of the same patients. If you don't talk to each other, then bad things are ultimately going to happen,” Dr. Lateef said, noting that it is common for medical ICU patients to receive care from six different services.

Dr. Raj Behal, associate chief medical officer at Rush, noted that “the important thing is that as we're looking at individual cases we're looking for patterns across cases, so if we have a medication error in the OR pharmacy, what is that telling us? It's probably no longer just about the error, it's pointing to a larger issue.” That larger issue is more likely to be identified when all disciplines participate together in the process.

Rush has begun to hold multidisciplinary M and M conferences to provide a forum for discussions of mistakes among different disciplines. A multidisciplinary M and M conference to tackle the treatment of massive pulmonary embolism, for example, revealed the lack of a clear protocol to guide care in the absence of an obvious best practice.

“Many specialties did not realize the abilities of the other specialties” involved in the treatment of massive pulmonary embolism, such as interventional radiology, interventional cardiology, and cardiac surgery. In this instance, “M and M acted as the recognition tool of a problem,” said Dr. Lateef, who is also medical director of the medical ICU. Rush's chief medical officer set up meetings to discuss expert opinions and data from a variety of disciplines. As a result, a protocol for massive pulmonary embolism was developed and has been used several times within the past year.

“The job of a good M and M conference is to ensure that those who have the ability to change hospital practice are aware of the key issues within the hospital,” Dr. Lateef added. At Rush, the chief medical officer is kept apprised of the results of all M and M conferences. “Administrators have the power to change things. They need to know what those things are.”

ROSEMONT, ILL. — Morbidity and mortality conferences can yield improvements more quickly than can any other quality or patient safety measure in a hospital, but only if all of the disciplines involved meet at the same table in a concerted effort to learn from errors and make lasting changes, according to Dr. Omar Lateef, director of the critical care safety program at Rush University Medical Center in Chicago.

“Currently, the 'M and M' model in most hospitals remains isolated by discipline, not geographic space,” with specialties such as medicine, surgery, cardiac surgery, and cardiology each holding separate conferences, Dr. Lateef said at the Joint Commission national conference on quality and patient safety.

This piecemeal approach of organizing conferences based on specialty fosters separatism, blocks communication, leaves other disciplines out of valuable learning experiences, and creates confusion that leads to errors, he said.

By way of example, he noted the patient with pneumonia who is placed in the cardiac intensive care unit and is given an aspirin before being given the appropriate initial antibiotic regimen, and the patient with a myocardial infarction who is placed in the medical ICU and is given antibiotics before receiving aspirin therapy.

These “cultural differences” based on specialty “aren't good when you're taking care of the same patients. If you don't talk to each other, then bad things are ultimately going to happen,” Dr. Lateef said, noting that it is common for medical ICU patients to receive care from six different services.

Dr. Raj Behal, associate chief medical officer at Rush, noted that “the important thing is that as we're looking at individual cases we're looking for patterns across cases, so if we have a medication error in the OR pharmacy, what is that telling us? It's probably no longer just about the error, it's pointing to a larger issue.” That larger issue is more likely to be identified when all disciplines participate together in the process.

Rush has begun to hold multidisciplinary M and M conferences to provide a forum for discussions of mistakes among different disciplines. A multidisciplinary M and M conference to tackle the treatment of massive pulmonary embolism, for example, revealed the lack of a clear protocol to guide care in the absence of an obvious best practice.

“Many specialties did not realize the abilities of the other specialties” involved in the treatment of massive pulmonary embolism, such as interventional radiology, interventional cardiology, and cardiac surgery. In this instance, “M and M acted as the recognition tool of a problem,” said Dr. Lateef, who is also medical director of the medical ICU. Rush's chief medical officer set up meetings to discuss expert opinions and data from a variety of disciplines. As a result, a protocol for massive pulmonary embolism was developed and has been used several times within the past year.

“The job of a good M and M conference is to ensure that those who have the ability to change hospital practice are aware of the key issues within the hospital,” Dr. Lateef added. At Rush, the chief medical officer is kept apprised of the results of all M and M conferences. “Administrators have the power to change things. They need to know what those things are.”

ROSEMONT, ILL. — Morbidity and mortality conferences can yield improvements more quickly than can any other quality or patient safety measure in a hospital, but only if all of the disciplines involved meet at the same table in a concerted effort to learn from errors and make lasting changes, according to Dr. Omar Lateef, director of the critical care safety program at Rush University Medical Center in Chicago.

“Currently, the 'M and M' model in most hospitals remains isolated by discipline, not geographic space,” with specialties such as medicine, surgery, cardiac surgery, and cardiology each holding separate conferences, Dr. Lateef said at the Joint Commission national conference on quality and patient safety.

This piecemeal approach of organizing conferences based on specialty fosters separatism, blocks communication, leaves other disciplines out of valuable learning experiences, and creates confusion that leads to errors, he said.

By way of example, he noted the patient with pneumonia who is placed in the cardiac intensive care unit and is given an aspirin before being given the appropriate initial antibiotic regimen, and the patient with a myocardial infarction who is placed in the medical ICU and is given antibiotics before receiving aspirin therapy.

These “cultural differences” based on specialty “aren't good when you're taking care of the same patients. If you don't talk to each other, then bad things are ultimately going to happen,” Dr. Lateef said, noting that it is common for medical ICU patients to receive care from six different services.

Dr. Raj Behal, associate chief medical officer at Rush, noted that “the important thing is that as we're looking at individual cases we're looking for patterns across cases, so if we have a medication error in the OR pharmacy, what is that telling us? It's probably no longer just about the error, it's pointing to a larger issue.” That larger issue is more likely to be identified when all disciplines participate together in the process.

Rush has begun to hold multidisciplinary M and M conferences to provide a forum for discussions of mistakes among different disciplines. A multidisciplinary M and M conference to tackle the treatment of massive pulmonary embolism, for example, revealed the lack of a clear protocol to guide care in the absence of an obvious best practice.

“Many specialties did not realize the abilities of the other specialties” involved in the treatment of massive pulmonary embolism, such as interventional radiology, interventional cardiology, and cardiac surgery. In this instance, “M and M acted as the recognition tool of a problem,” said Dr. Lateef, who is also medical director of the medical ICU. Rush's chief medical officer set up meetings to discuss expert opinions and data from a variety of disciplines. As a result, a protocol for massive pulmonary embolism was developed and has been used several times within the past year.

“The job of a good M and M conference is to ensure that those who have the ability to change hospital practice are aware of the key issues within the hospital,” Dr. Lateef added. At Rush, the chief medical officer is kept apprised of the results of all M and M conferences. “Administrators have the power to change things. They need to know what those things are.”