Mortality rate, especially early post intervention mortality, is a common indicator of healthcare quality. Regular mortality reviews are core clinical component of all units in the Southern Adelaide Local Health Network. We set out to examine the initial processes of the newly established Medical oncology Department’s Morbidity and Mortality meetings (MM) to evaluate the pattern of cases and impact on Department policies and practice.
Physician led MM review committee was established through invitation of relevant medical, nursing and allied-health professionals from Flinders Medical Centre Oncology Unit in May 2013. All deaths were discussed and coded during scheduled multi-disciplinary weekly ward meetings. All deaths < 30 days of systemic anticancer therapy (SACT), deaths or morbidity that was judged to be unanticipated (UA) or to have any quality improvement opportunity (QIO) were then discussed in detail at the monthly departmental MM meeting.
3105 patients initiated a new SACT between May 2013- July 2016 in the unit. 120 inpatient deaths occurred and were coded; 53 cases (mortality=44, morbidity=9) were referred to the MM committee for further review. 31 male and 22 female patient cases (age range 41-85 years) were discussed. Primary cancer diagnosis in majority was lung (n=13), followed by colon (n=8) and breast cancers (n=7). 90% had metastatic disease. The most common chemotherapy regimen received in the preceding 6 months was 5FU/CAPOX/FOLFOX +/- Bevacizumab. Mortality rate <30 days of SACT was 1% (n= 28). 11 cases were identified to have QIO and 13 cases were deemed UA. As a result of MM review process 3 clinical audits are underway and 3 consensus departmental guidelines have been developed.
Our experience shows that departmental MM review process is feasible and ensures all inpatient deaths are systematically reviewed. This process identifies QIO and can lead to quality improvement measures for implementation.