Standardization of Non-academic Center Surgical Morbidity and Mortality Conference: a Type I Hybrid Implementation Non-clinical Trial.

Study Overview
=================
Brief Summary
-----------------
Specific Aim 1: Determine impact of standardized morbidity and mortality (M&M) toolkit on provider satisfaction with, and perceived impact of, M&M conference. Specific Aim 2: Identify barriers and facilitators to toolkit implementation.

Detailed Description
-----------------
Design: - Pre-, post- intervention mixed-methods trial. Inclusion: o M&M conference attendees at enrolled level II and III trauma centers, inclusive of trainees, administrative staff, providers. Exclusion: Age < 18 Anticipated attendance at <= one M&M conference at study site. Intervention: Brief didactic regarding evidence base for M&M conferences. Sequential deployment of standardized M&M toolkit Standardized slide deck Code of conduct Conference planning checklist Case documentation form Recruitment: o Pre/post survey: M&M attendees will be invited to scan a QR code made available at the beginning of an M&M conference, and to take 5 minutes to fill the associated survey if they consent. o Semi-structured interview: The research coordinator contact information will be emailed to M&M listserv, requesting interested parties contact them to schedule an interview. Data collection o Specific Aim 1: Pre/post 10 question digital, anonymous mixed-methods (one free text question) survey • Demographics collected: occupation (surgeon / app / non-surgeon physician / other), years in practice (<10, 10-20, >20) Observation of M&M to capture: • # of attendees # of cases presented at each conference # of cases which include literature review # of cases which include determination of recommended system change (just culture..?) Specific Aim 2: Three, six and nine months after initial toolkit deployment we will conduct semi-structured interviews regarding implementation barriers and facilitators. Interviews will be conducted in-person and audio-recorded. Interview guide will be modified to emphasize opportunities for improvement identified in initial quantitative data collection. For instance, if baseline data suggests case referral is the primary problem, will triage discussion of this portion of the M&M process higher and ask additional detail regarding perceived means of improvement. The interview guide scope will not change from that submitted, the emphasis will pivot as described. Data analysis will be ongoing, and results of each interview set will be used to inform adaptation of implementation approach. Consent o Would like to submit a request for waiver of written consent and inclusion of information sheet in survey with confirmation of understanding but without signature, collection of names. Timeline o Baseline survey and observational data collection Feb - April 2022, intervention deployment March - May 2022, follow-up data collection Feb - April 2023. Study Sites o Northern Colorado M&M (Greeley, Longs Peak, Poudre Valley, Medical Center of the Rockies)

Official Title
-----------------
Standardization of Non-academic Center Surgical Morbidity and Mortality Conference: a Type I Hybrid Implementation Non-clinical Trial.

Conditions
-----------------
Surgery, Surgery--Complications

Intervention / Treatment
-----------------
* Behavioral: Morbidity and mortality conference toolkit


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: M&M conference attendees at enrolled level II and III trauma centers, inclusive of trainees, administrative staff, providers. Exclusion Criteria: Age < 18 Anticipated attendance at <= one M&M conference at study site.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>o Sequential deployment of standardized M&M toolkit at a regional M&M conference. | Behavioral: Morbidity and mortality conference toolkit<br>* Standardized slide deck Code of conduct Conference planning checklist Case documentation form<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perception of effective M&M conference | Participant endorses having seen a change at their institution attributable to a discussion at an M&M conference | one year | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Morbidity and mortality conference, Quality Improvement, Implementation Science