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Session: ePoster: Quality and Cost 9 (Sat315)

EP162 - The Need to Improve Colorectal M&M: An In-Depth Mixed-Methods Evaluation

Saturday, May 10, 2025
3:58 PM – 4:03 PM PT
Location: Monitor 8, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Sarah L. Remer, MD

    Clinical Scholar
    The American College of Surgeons, Division of Research and Optimal Patient Care
    Chicago, IL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Jessica K. Liu, MD, MS, MPH (she/her/hers)

    Clinical Scholar
    The American College of Surgeons
    Chicago, IL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Clifford Y. Ko, MD

    Director, Division of Research and Optimal Patient Care, American College of Surgeons Professor and Vice Chair of Surgery and Professor of Health Services, UCLA Schools of Medicine, and Public Health
    American College of Surgeons , CA, US

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AR

    Amy Robinson-Gerace, n/a

    Senior Manager, Verification Program Development
    The American College of Surgeons, Division of Research and Optimal Patient Care
    Chicago, Illinois, United States

    Disclosure information not submitted.

  • SE

    Shelby Eagle, MPH

    Project Manager
    American College of Surgeons
    Chicago, Illinois, United States

    Disclosure information not submitted.

  • ES

    Emily Sanders, MS, OTR/L

    Project Manager, Accreditation and Verification Program Development
    American College of Surgeons
    Chicago, Illinois, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Sarah L. Remer, MD: This individual has no financial relationships with ineligible companies.
Jessica K. Liu, MD, MS, MPH: This individual has no financial relationships with ineligible companies.
Clifford Y. Ko, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Morbidity and mortality conferences are engrained in surgical programs and are often viewed as a dreaded “necessary evil” to those presenting cases. Case review processes however are critical to improving outcomes for surgical patients, assisting surgeons in improving their practice, and allowing hospitals to deliver safe high-quality surgical care. Effective case review should include three steps: 1) inclusion/selection process, 2) formal case conference, 3) and a loop closure process. Because of its complexity, colorectal surgery has opportunities to lead in quality improvement. For this reason, efforts to evaluate and improve case review should be undertaken. This study aims to evaluate the rigor of case reviews being conducted in colorectal surgery. We hypothesized that there will be areas of variation on which to improve.

Methods/Interventions: This mixed methods study was an in-depth review colorectal services from March 2023 to September 2024. Colorectal services were individually scored (0-3) on Steps 1 and 3 of the case review process using a standardized protocol for qualitative interviews and surveys with quantitative scoring. Step 2 was scored based on presence/absence of a formal, well attended case review conference. Descriptive statistics were used to analyze scoring data. Comments from the interviews were assessed for thematic analysis.

Results/Outcomes: Eight hospitals were evaluated in the study. They were primarily academic teaching hospitals (75%). Average colorectal case volume was 414 cases per year. 50% of programs had an above average rated inclusion/selection process, 50% had a formal case review conference dedicated to colorectal surgery, and 38% had an above average rated documentation and loop closure process. Scores for each of the three steps were 1-2, absent/present, and 0-2, respectively.

Overall, two programs (25%) earned above average ratings for all three steps. Two programs were rated above average in two of the steps, two programs had above average ratings in one step, and two programs did not achieve above average ratings for any step in the case review process. Of note, the programs that achieved above average ratings on all steps were academic teaching institutions with smaller than average bed size (mean 454) and colorectal case volume (mean 306). Full results are found in the table. On qualitative analysis of comments from interviews, some hospitals mention having processes in place at a hospital level but not a specialty level with varying degrees of formality. Common themes for all steps were informality and lack of protocols/systems. Competing priorities was identified as a barrier by most programs.

Conclusion/Discussion: Case review such as M&M is being performed with variability in terms of the presence and rigor of critical components of the process at the colorectal specialty level. However, it is possible for programs to achieve high quality case review. Review of appropriate cases needs to be done at a specialty level and not solely a hospital level to ensure involvement of experts in the field. Improving case review is a feasible way to improve quality surgical care and thus to advance the field of colorectal surgery.