Mortality Meetings: Analysis of 12 years of Functioning in an Intensive Care Unit of Cardiac Surgery
Paul M. MENU, Sr., Jamil H. Hajj-Chahine, Hassan M. Houmaida, Hassan M. Houmaida, Laurent SOUBIRON, Claire Biderman, Pierre J. Corbi.
CHU de POITIERS, Poitiers, France.
OBJECTIVE: Mortality meetings (MM) became a modern approach in improving the quality and the safety of the cardiac patient care. It is also a collective approach of learning favouring the dialogue between surgeon and anaesthesia caregivers and gives us instructive argumentation for the choice of the strategy for the best surgical management. The MM is a global analysis of a situation estimating the organizational, technical and human parameters
METHODS: All our mortality and morbidity files considered instructive were reviewed. Every case is presented by a member of the team according to a well established plan, and then comes an opened discussion with analysis of every element between all the participants. The objective is to answer the questions: how arrived the event? Why did it happen? What it is necessary to implement to avoid that in the future
RESULTS: All the cases were analyzed, with the issue of the methodological guidelines of the HAS " the not making guilty of the people having participated in the taking care is indispensable to the objectivity and to the success of the research of the causes " This has allowed to federate the team around a common objective, in a constructive state of mind.
Numerous decisions were taken; the identification of improvement actions and the individualized follow-up of these actions were very fertile. The analysis of the haemorrhagic complications made us to establish a predictive score of the patients at risks and an algorithm for the decision-making. The study of the infectious complications made us bring to light markers by following the method ALARM. The integration of the paramedical teams is enriching to analyze the organizational parameters. The analysis of outcomes of valve replacement in the high risk patients helps us to decide between TAVI and conventional valve surgery
CONCLUSIONS: Our MM were validated by the Medical committee of our Establishment. Our MM of cardiac surgery are now considered in the certification and in the accreditation of the surgeons and the anaesthetists.
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