A Quality Improvement Project: The Implementation of a Nurse Driven Morbidity and Mortality Review in an Emergency Department Setting

Abstract Background: Morbidity and mortality reviews/conferences (MMR) are a mandatory curriculum requirement for medical residency programs throughout the United States to identify and reduce medical errors. Only within the past few decades have hospital organizations expanded MMRs to multidisciplinary teams to include medical professionals who are rendering care at the bedside more than medical providers. Purpose: This quality improvement (QI) project focuses on the application of a nurse drive MMR amongst emergency department (ED) nurses in a community hospital in Northern Bergen County, New Jersey. This ED nurse driven MMR measured the ED nurse’s knowledge and confidence levels as it applies to treating specific patient clinical presentations, if there was a knowledge improvement after reviewing the MMR, if the review contributed to their clinical confidence, and if there was an organizational workflow issue that contributed to the patient’s outcome. Methods: The cases were selected based on nurse and/or provider reporting, patient transfers from the ED, and/or patients who expired in the ED or during the hospital admission. A retrospective chart review was performed on each selected patient case to obtain all pertinent data to review the case. All patient identifiers were redacted. An online clinical resource tool, DynaMedex was utilized to provide the nursing staff with evidence-based practice (EBP) and clinical approaches to disease specific care. A two-tailed, paired t-test analysis was applied along with Hedges’ g to measure effect size of the paired sample tests. Results: This QI study rendered significant findings in multiple MMR sessions (sessions 2, 3, and 4) pertaining to the nurse’s increased confidence scores from the pre-MMR survey to post MMR survey, (p=< 0.05). There was one significant increase in the knowledge category in the MMR session #3 (p=< 0.05); other knowledge sections in the MMR sessions 1, 2, and 4 all illustrated an overall increase in the post-MMR survey; these findings were not deemed significant. Conclusion: The implementation of the ED nurse driven MMR yielded both clinical and statistically significant results across both knowledge and confidence levels. This QI implementation enlightened the nursing staff to specific patient outcomes, disease specific reviews, broadened their clinical assessment to treat the patient with more than one potential clinical pathology, and aided the nurses to identify system wide contributions that may or may not have contributed to the patient’s outcome. Keywords: morbidity and mortality review, emergency department, nurse, quality improvement, interdisciplinary approach