Arjmand, Ellis M.

ObjectiveThe objective is to describe variations in the otolaryngology morbidity and mortality (M&M) conference and to compare with other specialties.DesignCross‐sectional survey.SettingThe setting included otolaryngology departments across the United States and nonotolaryngology medical and surgical departments at 4 academic medical centers.Subjects and MethodsParticipants were members of a national otolaryngology quality/safety network and nonotolaryngology quality leaders at 4 large academic hospitals. Surveys were administered January 2017. Respondents described M&M conference practices, goals, and educational role.ResultsTwenty‐eight of 39 individuals representing 28 institutions completed the otolaryngology survey (72% response rate). Of 197 individuals, 60 (30% response rate) representing 11 surgical and 20 nonsurgical specialties completed the comparison survey. Twenty‐seven of 28 otolaryngologists (46 of 60 nonotolaryngologists) worked in academic settings. All otolaryngology programs conducted an M&M conference: 54% discussed all adverse events and errors; 32% used standard case selection processes; 70% used structured discussion, usually root cause analysis (64%); and 32% classified harm level. In comparison with other specialties, otolaryngology programs were more likely to discuss all adverse events and errors (P =. 01). Most conferences led to quality projects and intrainstitutional communication: 22% communicated to patients and families; 73% of respondents thought that M&M conferences should be standardized or use “best practices.” In both surveys, improving patient care was rated the conference’s most important function, followed by trainee education and culture change. Patient care and practice‐based learning were rated the most relevant Accreditation Council for Graduate Medical Education Core Competencies in both surveys.ConclusionsAcademic otolaryngology M&M practices generally align with other specialties, but specifics vary widely, making collaborative quality improvement challenging. Educational and administrative priorities cross specialties. Most respondents thought that standardization and best practices are worthwhile. Nonacademic practice data are needed.

Objectives(1) To describe the application of a detailed cost‐accounting method (time‐driven activity‐cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy.Study DesignProspective cost analysis case study.SettingTertiary pediatric hospital.Subject and MethodsAll otolaryngology providers and otolaryngology operating room staff at our institution.ResultsTime‐driven activity‐based costing demonstrated precise per‐case and per‐minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per‐case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements.ConclusionTime‐driven activity‐based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency.