1. Mortality and Morbidity Conference
Date

2. Patient and Procedure Age / Sex Primary Diagnosis Procedure Performed
Past Medical / Surgical History
Medications
Other Pertinent History

3. Clavien-Dindo Complication Grade
Grade V: Mortality
Grade IV: End organ failure (e.g. acute kidney injury, MI / CVA / respiratory failure)
4a: single organ failure
4b: MODS
Grade IIIB: Re-operation requiring general anesthetic (e.g. take back to OR)
Grade IIIA: Intervention not requiring general anesthetic (e.g. IR drain, endoscopy)
Grade II: Medical Intervention (e.g. antibiotics, blood transfusion)
Grade I: Supportive care only (e.g. IV fluids)

4. Attribution Table Diagrams Patient Factors Provider Factors
System Factors
Swiss cheese, or
Fish bone

5. QI: Fishbone diagram

6. QI: Swiss cheese diagram