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Mortality meetings in geriatric medicine: strategies for improvement.

ABSTRACT: A large proportion of patients who die in hospital will be under the care of geriatric medicine. Mortality reviews have traditionally used trigger tools to try and identify preventable deaths, but the majority of hospital deaths are not preventable and lapses in care are often very complex. Over a period of 14 months we performed four PDSA cycles to change the focus of mortality meetings within care of the elderly and stroke medicine at Cumberland Infirmary to look beyond preventable deaths. The aim was to maximise learning from mortality meetings to improve patient care. We used collaborative working at a trust and departmental level, moving from trigger tool preparation to a narrative approach, and we set up strategies to focus and disseminate our learning. The mean number of cases discussed per meeting and the mean number of lessons identified per case discussed increased, as did the learning levels (trust, department, individual). Maintaining multidisciplinary input and consolidating lessons learnt was difficult because of clinical commitments and natural staff turnover.

SUBMITTER: Dunbar J

PROVIDER: S-EPMC4645940 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Mortality meetings in geriatric medicine: strategies for improvement.

Dunbar Joanne J George James J

BMJ quality improvement reports 20150317 1

A large proportion of patients who die in hospital will be under the care of geriatric medicine. Mortality reviews have traditionally used trigger tools to try and identify preventable deaths, but the majority of hospital deaths are not preventable and lapses in care are often very complex. Over a period of 14 months we performed four PDSA cycles to change the focus of mortality meetings within care of the elderly and stroke medicine at Cumberland Infirmary to look beyond preventable deaths. The ...[more]

PMID: 26734372

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Project description:ObjectivesThe American Cleft Palate Association-Craniofacial Association (ACPA-CPF) recommends regular multidisciplinary team meetings for comprehensive craniofacial patient care, yet standardized meeting guidelines are lacking. Lack of standardization may result in varying quality of care within and between institutions, as well as difficulty in creation of new multidisciplinary craniofacial teams at institutions without one. This study sought to assess craniofacial multidisciplinary team meetings and determine the utility of a meeting guidance tool in such meetings. It was set in a single institution's craniofacial center, and participants included multidisciplinary team members.MethodsThis project used the Plan-Do-Study-Act quality improvement method, completed in two phases. In the project's first phase, craniofacial team members assessed their current meetings with an evaluation instrument previously created. The evaluation results identified areas needing improvement, and a new meeting guide was created and implemented over four meetings. Team members also completed a survey comparing historical versus new meeting structures.ResultsInitial meeting quality was perceived positively, but evaluation with a standardized instrument revealed deficiencies, particularly in case presentation topics. Implementing a custom guide improved the provision of current and historical patient information and treatment plan summarization, although excessive repetition persisted. Adjustments to the custom meeting guide led to further quality enhancement, particularly in case presentation efficiency and meeting effectiveness.ConclusionMultidisciplinary team meetings are vital for comprehensive craniofacial care, but ensuring consistent quality is challenging. Our study demonstrates the value of utilizing standardized meeting guides to evaluate and create custom guides leading to quality improvement. Ongoing refinement is essential to address persisting issues and optimize patient outcomes.Level of evidence5.

Dataset Information

Mortality meetings in geriatric medicine: strategies for improvement.

Publications

Mortality meetings in geriatric medicine: strategies for improvement.

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