Abu-Zidan and Premadasa (11) | Single surgical department identified perception of MMC, implemented changes, and used a postintervention 5-point questionnaire |
Notification of cases to present 2 days before MMC Presentation limited to 15 minutes Mandatory literature summary
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Antonacci et al. (41) | Three hospitals and 1 ambulatory care facility implemented an error analysis methodology and provided report cards to individual surgeons |
Standardized case critique (what, who, why, when) Analysis of adverse events for quality-dependent factors Potential quality issues were identified via consensus and graded< Adverse events caused by quality issues were sent to surgeons and chairperson as a report card
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Reduction in age-adjusted mortality Privileges restricted or removed for surgeons (3%) Pushback from surgeons Three times greater identification of quality issues
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Implementation of error analysis may be difficult at community hospitals Lacks cost–benefit analysis and analysis among institutions Lacks preintervention comparison
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Auspitz et al. (19) | Single surgical department retrospectively reviewed all cases submitted to MMC and compared results to local NSQIP registry |
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Similar reporting in portion of major and minor complications between NSQIP and MMC NSQIP identified a higher proportion of wound site infection and readmissions NSQIP identified 30-day postoperatiove outcomes MMC captured nonoperative cases
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Bhalla et al. (32) | Single academic centre’s department of surgery compared traditional MMC format to the matrix format and assessed improvement with pre- and postintervention questionnaires |
PGY 1–3 assigned weekly readings and PGY 4–5 assigned evidence-based literature reviews Presentations assigned 2–5 days in advance Audience response system Post-MMC matrix newsletter Standardized case selection by MMC moderator
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Residents spent less time preparing and reported learning more Enhanced learning reported from other presentations Matrix format was significantly more preferred Faculty and resident perceived greater presentation quality
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Small sample size with drop-off in responses Potential for Hawthorne effect Increased MMC presentation may be because of enhanced MMC appreciation not format change
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Clarke et al. (35) | Single hospital retrospectively reviewed MMC format change and analysis using error taxonomy |
MMC was run by a dedicated moderator Standardized PowerPoint template Taxonomic analysis (domain, impact, type, cause and prevention) of adverse events for human-related error
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Cromeens et al. (20) | Single pediatric surgical service retrospectively compared NSQIP-P to morbidity and mortality identified by MMCs |
Increased MMC frequency from bimonthly to weekly Reported straightforward complications Retrospective use of NSQIP-P to identify complications
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No difference in mortality identified between MMCs and NSQIP-P Increased MMC reporting of morbidity with format changes Increased reporting of morbidity by NSQIP-P as compared with MMCs
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Cromeens et al. (42) | Single pediatric surgical service implemented a taxonomic error analysis strategy and standardized MMC structure |
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Falcone and Watson (38) | Multiple campuses at a single medical centre used teleconferencing to improve MMC attendance and provided a cost–benefit analysis |
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Greco et al. (39) | Single division of general surgery invited a clinical librarian to MMC and assigned research questions to MMC attendees, to be completed with librarian assistance |
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No objective analysis of outcomes Limited to centres with access to a clinical librarian Limited postintervention feedback
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Gurien et al. (17) | Single department of surgery retrospectively compared NSQIP and MMC registries for commonality |
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Hutter et al. (18) | Single general surgery service retrospectively compared data from MMC and NSQIP registry for commonality |
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NSQIP captures only operative patients, whereas MMC also captures nonoperative Small sample size limited subgroup analysis Suggested creation of an NSQIP integrated Web-based reporting for MMC
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Kim et al. (29) | Five divisions from 1 department of surgery employed format changes to their MMC and assessed efficacy with a pre- and postintervention questionnaire |
Presenters instructed to provide brief clinical histories and literature reviews Presentation limited to 15 minutes Instruction to analyze case presented for underlying cause of complication(s) Electronic sample presentation template provided
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Presentations lasted 15–20 minutes owing to questions Increased specificity of the cause of complication Increased specificity of future practice change(s) Increased positive response from residents
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Kong and Clarke (34) | Single metropolitan trauma service introduced a structured MMC and HEMR to report morbidity and mortality |
HEMR used to capture routine data, generate reports on morbidity and mortality, and compare with MMC data Introduction of a multidisciplinary MMC
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HEMR increased morbidity, specifically for systemic complications Increased identification of common clinical scenarios associated with error and morbidity
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Lewis et al. (37) | Single department of surgery conducted a prospective study in which participants were randomly assigned to attend MMC live or via televideoconference and response was assessed with an anonymous survey |
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No significant difference in learning among faculty, residents, and students No significant difference in perceptions Increased favourable perceptions for televideoconferencing as commuting distance increased
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Potential for decrease in audience interaction with televideoconferencing Uneven representation in faculty, residents and student participants Number of questions to detect learning may have been inadequate
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McVeigh et al. (21) | Single department of surgery conducted a prospective comparative study over 6-mo period concerning reporting of adverse events comparing MMC and a proforma |
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Mitchell et al. (12) | Single department of surgery conducted prospective study concerning standardization format for MMC using preand postintervention questionnaires and a multiple-choice questionnaire (MCQ) to assess knowledge |
Standardized SBAR presentation format Mandatory resident and faculty attendance Decreased defensiveness and blame Mandatory use of PowerPoint Radiographic images encouraged Focused analysis of error Integration of evidence-based literature Facilitated audience participation Facilitation of the conference by a moderator
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SBAR was positively regarded by presenters and reported as easy to implement Modified MMC format did not add to preparation time Presentation quality improved significantly in background, assessment, and recommendation Improved MCQ scores from all learners
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Mitchell et al. (33) | Single department of surgery conducted a prospective observational study testing a modified MMC presentation format |
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Increased presentation quality Increased communication clarity Increased attendee satisfaction Increased identification of remediation strategies
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Murayama et al. (30) | University medical school conducted a prospective observational test using a 23-item survey before and after implementation of a modified MMC format |
Quicker summary of pertinent aspects of cases (5–10 min) Limited literature review (5–10 min) Discussion stimulated by moderator Moved from 6 pm to 7 am Residents encouraged to discuss case with attending prior
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Increased faculty and resident attendance Increased faculty contribution and analytical thinking Residents preferred modified formats Attending surgeons disliked shorter literature review
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Small sample size Single centre Drop-off in survey response between pre- and post Greater resident response, skewed to juniors Possible Hawthorne effect
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Prince et al. (36) | Single department of surgery at a tertiary academic medical centre implemented an interactive MMC format and analyzed the effectiveness using a questionnaire |
Directed questions to audience Provided explanations during session Asked questions to attending faculty members Included illustrative slides and videos Moderator stimulated and facilitated discussion
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Incomplete or missing data Hawthorne effect and practice effect may have been confounding Prospective longitudinal analysis Lacks preintervention comparison
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Risucci et al. (31) | Single department of surgery conducted a prospective study in which a modified MMC was investigated using pre- and postintervention questionnaires |
Conference lengthened from 60–90 min with 3 cases presented Mandatory PowerPoint use that followed a uniform format concerning timing of diagnostic inquires, consultations, and procedures Mandatory brief literature review Increased multi-disciplinary attendance Error discussion is focused on timeliness and appropriateness of diagnosis and treatments
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Consensus was reached more often Complications were perceived as more often avoidable Strategies for prevention were more likely to be identified Increased percentage of complications attributed to errors in judgment Speculation that modified MMC facilitates more detailed description and analysis of a patient’s entire clinical course
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Vogel et al. (40) | Single department of surgery conducted a prospective study which incorporated MMC findings into a PDCA cycle |
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