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ニューロサイエンスの旅 Vol. 63

当科の柏崎大奈先生の研究成果がWorld Neurosurgery誌に掲載されました。2013年以降、われわれは日常の診療行為(手術、検査、病棟管理など)によって生じるインシデント、合併症を検証して予防策を講じるため、6ヶ月ごとにMorbidity & Mortality (M&M) Conferenceを開催してきました。M&Mカンファランスがわれわれの診療にどのような効果をもたらすのかを解析したところ、M&Mカンファランスは、予見・回避可能な合併症を5年間で7.5%から4.2%に有意に減少させること、そして、スタッフドクターよりもレジデントでその教育効果が高いことが明らかとなりました。当科のメンバー全員のたゆまぬ努力の成果です。
 今後もこの結果に満足することなく、インシデントや合併症を減少させる努力を継続したいと考えています。

A Voyage to Depth of Neuroscience Vol. 63

One of our staffs, Dr. Daina Kashiwazaki and all of our members published the educational effects of every 6-month Morbidity & Mortality Conference on the incidence of M&M in World Neurosurgery journal.

Kashiwazaki D, Saito H, Uchino H, Akioka N, Hori E, Shibata T, Tomita T, Akai T, Kuwayama N, Kuroda S.
World Neurosurg. 2019 Sep 12. pii: S1878-8750(19)32448-9. doi: 10.1016/j.wneu.2019.09.018. [Epub ahead of print]

 

Abstract
Background: Morbidity and mortality conferences (MMCs) are now widely implemented in clinical hospitals, but their impact on the education for neurosurgeons remains limited.
Objective: This prospective study was aimed to assess the efficacy and benefit of MMCs on the education for neurosurgeon.
Methods: All morbidity and mortality events were prospectively recorded and were categorized on the basis of two viewpoints. First, they were classified into “avoidable” and “unavoidable” events, based on the quality of each event. Simultaneously, they were classified into 3 groups, including the residents, attendant members, or unclassifiable, based on the experience of the neurosurgeon who were most closely related to each event. The information was compared between early (2013-2014) and late (2015-2017) study periods in order to evaluate the education value of MMCs.

Results: During a 5-year study period, 44 mortality (2.1% per patient) and 201 morbidity events (9.7% per patient) were recorded. There were no significant differences in the incidence of mortality between two periods (P=0.52). The incidence of morbidity significantly decreased from 11.5% (83/723) to 8.4% (118/1403; P<0.04). Of these, “avoidable” events, but not “unavoidable” events significantly decreased from 7.5% (54/723) to 4.2% (59/1403; P=0.001). The decrease in the incidence of “avoidable” morbidity was more pronounced in the residents than in the attendant members (P=0.007 and P=0.04, respectively).
Conclusion: Knowledge acquisition from MMCs can significantly reduce the “avoidable” morbidity events in both residents and experienced neurosurgeons. The educational effect was more distinct in the residents.

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