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A statewide initiative known as the Michigan Urological Surgery Improvement
Collaborative (MUSIC) is a collaboration among urologists treating prostate
cancer in the state of Michigan. The database is designed to share data in order
to improve quality and value of care as well as enhance outcomes in prostate
cancer treatment. This is an example of a smaller, physician-led quality
improvement project that generates useful data that may be used in retrospective
analysis and leads to local or national improvements in quality improvement
measures [ 28 ].
M&M/Safety Reporting
Surgical morbidity and mortality (M&M) conferences have long been utilized
quality assurance programs in surgical residency programs with little change in
format and structure for nearly 100 years [ 1 ]. In these educational conferences,
surgical complications are reviewed and discussed in an attempt to learn from
mistakes or to be aware of risk factors in patients for certain complications.
M&M conferences were made a requirement for all surgical training programs in
1983 by the ACGME. Therefore, resident participation in M&M conferences is
generally accepted as a vital aspect of quality improvement and patient safety
training in residency training [ 8 ]. Although important, a recent study from one
institution found that institutional rates of complication reporting are often much
lower than national rates or institutional rates reported to ACS NSQIP [ 1 ]. Given
this result, training programs should accurately review outcomes to ensure their
validity.
OR Etiquette and Checklists
An important aspect of patient safety in surgical residencies is ensuring that
proper OR etiquette is maintained, including obtaining informed consent,
appropriate site marking, time-out before and after all surgical procedures, and
appropriate handoff of care. In addition, checklists are an important aspect of
modern surgical care and help to reduce otherwise preventable complications. In
2008, the World Health Organization (WHO) published a set of guidelines in a
global initiative to improve the safety of surgery. An important component of
these guidelines included establishing a surgical safety checklist to ensure that the
correct procedure for the correct patient was being performed and that potential
life-threatening complications are avoided [ 29 ]. This includes separate preanes-
thesia, pre-incision, and post-procedure time-outs, which have been widely
accepted and implemented. Using the WHO surgical safety checklist in the oper-
ating room has been shown to be a feasible way to reduce all-cause morbidity
regardless of operative site [ 30 ].
E.L. Ferguson and C.P. Sundaram