By analyzing errors that lead to preventable or potentially preventable deaths in trauma care, healthcare organizations can develop mitigation strategies to prevent those errors from reoccurring. This study classified events anonymously reported by trauma centers using the Joint Commission on Accreditation of Healthcare Organizations Patient Safety Event Taxonomy. Mitigation strategies were most often low-level, person-focused (e.g., education and training).

This study demonstrated that discussion of cases at traditional morbidity and mortality (M&M) conferences did not lead to increased risk of litigation. Investigators at a single academic institution used a trauma registry (risk-management database) along with minutes from M&M conferences to evaluate the ratio of lawsuits filed to patients admitted, those admitted with complications, and those presented at M&M conferences. The authors discuss the clinical and legal information from selected malpractice suits but ultimately suggest that their findings support educational venues to discuss medical errors. Furthermore, they discuss the importance of such activities in the context of the patient safety movement and performance improvement activities. A past study evaluated M&M conferences in both surgery and internal medicine to determine the frequency with which cases involving medical errors are discussed.