1. Morbidity Mortality Readmissions Referrals
GICU M&M&R&R Meetings
Morbidity
Mortality
Readmissions
Referrals

2. Aims Identify governance issues
Open discussion among the team on quality of clinical care
Possible care process redesign and policy update
Education

3. Classification reviewed by consultant of the week
Classification of events & deaths
Classification reviewed by consultant of the week
Weekly presentation
No Concerns
1 Slide: Standard template
Presentation updated with issues
“O” Drive
Expanded case review
Incident Report
Concerns
Weekly
Monthly
Monthly report compiled
Education & Governanace issues identified
Care Group Meeting
Consultant Meeting
Other output/ plan

4. M&M&R&R Presentation
Weekly: Every Wednesday (Tuesday on last week of the month)
GICU Seminar Room
All staff welcome
Trainee presenting expected to update slides with relevant issues and send them to consultant team via for upload to O drive
Rota of individuals responsible set in advance and available on Yammer and GICU website
Templates are HERE

5. Morbidity events
Anything that was a near miss or actually resulted in patient (or staff) harm
Very brief contextualised summary
Datix completed Y / N
Actions / learning points
Duty of candour fulfilled Y/N

6. Mortalities Classification of death Action for each classification
No Concerns
Standard template slide in weekly presentation
Concerns (pre GICU & / or in GICU)
Standard template + Expanded case summary

7. Standard Template Slide – No concerns
Initials, MRN, Age
Date of Death, duration of stay
Main reason for admission
Relevant diagnoses
Any end-of-life care issues? (Including organ donation)
Death Certificate (if issued): I a b c II
Check that there is an Episode Summary on iCLIP (or referral to coroner template uploaded to iCLIP)

8. Expanded case summary – Some concerns
Complete standard template slide THEN
Background / clinical presentation / management / HIGHLIGHT CONCERNS
Concise, concentrating on major issues / events
Open discussion
RECORD - Lessons learned identified (added to presentation)

9. Lesson learnt / Actions to take place:
Datix form completed?
Feed back to admitting team? Y / N

10. Readmissions How many? For each instance Initials, MRN, Age
How long between ICU step down and readmission?
Was readmission
Elective (planned) OR Emergency (unplanned)
Preventable (Predictable) OR Unpreventable
Any concerns / issues?
Any lessons learnt / actions to be taken

11. Referrals How many? Any concerns / issues / themes?
Any lessons learnt / actions to be taken?

12. Minutes Standard Excel Sheet To be filled in by trainee presenting
Includes Attendance register
Minutes file and Presentation to be sent by to

13. Monthly report to Care Group Meeting
Presents M&M data from previous month
Total number
Classification
Learning points identified
Governance issues identified/ proposed action
Feedback on action items from previous report

14. Monthly: Case presentations; jointly with ED
Once a month (4th Wednesday)
One hour meeting:
University Lecture Theatres
Expanded case summary + / - mini topic review

15. Team & Responsibilities
Consultant of the week
Chair the meeting held on your GICU (Red) Week
Reviews classification of death for all patients
Identify Morbidity that warrants referral to M&M&R&R meeting
Registrar of the week
Compiles mortality and prepares presentation based on guidance above
Liaison with consultant re “concerns” in care and cases of significant Morbidity
If registrar is not presenting, supervises trainee presenting in preparing an appropriate presentation
All trainees will be expected to present at least one M&M meeting
EM Trainees will prepare a case for the monthly joint meeting