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In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The "Hostile Abdomen Index" has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.
Surgeons ARE now being forced to answer the questions: how good are we and how do we know? These unstructured questions are sometimes met with surgical angst and annoyance. The requirements of quality assurance, patient safety, error reporting, and remedies have been magnified by insurance and payor guidelines, consumer advocate groups, evidence-based medicine criteria, media, hospital control organizations, specialty boards, malpractice issues, credentialing measures, and residency training programs. Evolving pay-for-performance initiatives are not uniform. The angst associated with measuring how good we are or the quality of our surgery is complicated because there is no national agreement as to data sources or decision algorithms for those questions. In 1991, Brennan and Leape1 noted that there was "a significant reduction in the overall rate of complications during the second part of the study period after feedback was given to the surgeons regarding outcomes." They also noted that "quality improvement based on outcomes data is usually easy, because obvious problems are identified and remedied." However, obvious problems may not be remedied without realistic understanding on the part of surgeons. As far as disclosing medical errors to patients, Chan2 indicated that "surgeons used the word error in 57 per cent, took responsibility for the error in 65...