Clinical trial NCT05286411: Evaluation of the Implementation of a Quality Improvement Program Through Morbidity and Mortality Reviews
Official title: Evaluation of the Implementation of a Quality Improvement Program Through Morbidity and Mortality Reviews in a Developing Country
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Quality Improvement
Keywords: morbidity and mortality reviews
implementation
quality improvement
patient safety
Lead sponsor: Moroccan Society of Surgery
Sponsor class: OTHER
First posted: 2022-03-18
Enrollment: 13
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients who underwent a curative surgical procedure for a digestive cancer in our department during the study period and who presented severe adverse events in 90 post operative day

Brief summary: Morbidity and mortality reviews represent an opportunity to discuss adverse events and healthcare issues. Aim is to report the first experience of implementing a standardized procedure of morbidity and mortality reviews, and assess its impact on quality improvement.

Detailed description: From July 2019 to December 2019, members of the surgical and intensive care unit departments designed and implemented a regular procedure of morbidity and mortality reviews. Cases of severe postoperative complications after curative resection for digestive cancer were selected to be presented by a surgical resident and discussed in an interdisciplinary conference following a standardized presentation based on an analysis tool adapted from the ALARM framework. Process was assessed by the number of morbidity and mortality reviews held, number and type of recommendations issued and implemented.

Among 13 serious complications during the study period, 10 were discussed. The "Tasks" category was activated in 90% of the cases where lack or misuse of protocols was identified in 90% of the events discussed. Test results availability or accuracy were incarnated in 30% of cases. Poor communication was a contributing factor in 60% of the cases. Written medical records were defective in 40% of the cases. From 16 recommendations for improvement emitted, 87.5% (14/16) were translated into projects and successfully implemented.

Thus, a standardized and regular procedure of morbidity and mortality reviews in a tertiary care facility in a developing country allowed a significant improvement in patient care through quality initiatives implementation. Morbidity and mortality reviews might be a strong tool for the improvement of surgical care particularly for low-mid income countries

Eligibility criteria: Inclusion Criteria:

* severe adverse events defined as postoperative morbidity \> 3a according to the Clavien Dindo grading system
* within the first 90 postoperative days of surgery
* Cases discussed in a morbidity and mortality review

Exclusion Criteria:

* Cases not discussed in a morbidity mortality review

Primary outcomes:
measure: Process assessment
timeFrame: one year
Secondary outcomes:
Other outcomes:
Locations:
city: Rabat
country: Morocco
facility: National Institute of Oncology
Study officials:
affiliation: National Institute of Oncology
name: Oumayma Lahnaoui, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: National Institute of Oncology
name: Anass Majbar, MD
role: STUDY_DIRECTOR
References:
citation: Houssaini K, Lahnaoui O, Souadka A, Majbar MA, Ghanam A, El Ahmadi B, Belkhadir Z, Amrani L, Mohsine R, Benkabbou A. Contributing factors to severe complications after liver resection: an aggregate root cause analysis in 105 consecutive patients. Patient Saf Surg. 2020 Sep 29;14:36. doi: 10.1186/s13037-020-00261-7. eCollection 2020.
citation: Souadka A, Benkabbou A, Al Ahmadi B, Boutayeb S, Majbar MA. Preparing African anticancer centres in the COVID-19 outbreak. Lancet Oncol. 2020 May;21(5):e237. doi: 10.1016/S1470-2045(20)30216-3. Epub 2020 Apr 3. No abstract available.
citation: Souadka A, Majbar MA, Essangri H, Amrani L, Benkabbou A, Mohsine R, Souadka A. Functional outcomes over time following perineal pseudocontinent colostomy reconstruction after abdominoperineal resection for ultralow rectal adenocarcinoma. J Surg Oncol. 2020 Sep;122(4):753-759. doi: 10.1002/jso.26074. Epub 2020 Jun 20.
citation: Majbar MA, Courtot L, Dahbi-Skali L, Rafik A, Jouppe PO, Moussata D, Benkabbou A, Mohsine R, Ouaissi M, Souadka A. Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A "real life" study in a developing country. J Visc Surg. 2022 Jun;159(3):187-193. doi: 10.1016/j.jviscsurg.2021.04.004. Epub 2021 Jun 4.