Running Head: PROFESSIONAL MEETING PAPER 1

Professional Meeting Paper

Bon Secours Memorial College of Nursing

February 17, 2017

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Mortality and Metrics

A mortality and metrics meeting is a meeting that the St. Mary’s Hospital cardiac

catheterization lab employees attends monthly to discuss cases that ended in death. The overall

purpose of the meeting is to discuss cases that ended in death and determine what the doctor

feels he or she did right. There is open discussion between the doctor that was assigned to the

case and other healthcare workers that attend the meeting to determine if something else could

have been done to prevent the death from occurring. During this mortality and metrics meeting,

the case discussed was about an elderly woman that presented to the emergency department with

an S-T elevation on her electrocardiogram. The woman ultimately died during the cardiac

catheterization. The case ended up being an ethical dilemma. The doctor assigned to the case had

to decide whether he was going to try to save the woman’s life or the metrics.

Application of Course Material

The mortality and metrics meeting had a mix of employees that range the intra-

professional team. There were doctors, the nurse manager from the cardiac catheterization lab,

nurses from the cardiac catheterization lab, and administrative personnel. This meeting displays

the organizational aspect of the hospital. There were multiple levels of employees that were

welcomed to discuss the case together. This meeting displayed the chain of command shown in

the cardiac catheterization lab. The administrative personnel are over the doctor, who is over the

nurse manager of the catheterization lab, who is over the nurses of the catheterization lab. The

doctor makes decisions based on the policies put in place by the administrative personnel, the

nurse manager makes decisions based on the orders of the doctor, and the nurses make decisions

based on the decisions of the nurse manager.

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During the mortality and metrics meeting, one of the attendees, a cardiothoracic surgeon,

asked the doctor assigned to the case being discussed why he did not order an echocardiogram

for the patient to determine ejection fraction before taking the patient into the catheterization lab.

The doctor assigned to the case argued that his decision was correct because he knew that the

patient was actively having a myocardial infarction and needed the blockage opened. It was also

brought to attention that when the patient was rapidly declining, the doctor ordered a STAT

echocardiogram and the echocardiogram technician refused to come to the catheterization lab.

The physician assigned to this case was displaying ethical knowing. Ethical knowing focuses on

a person’s moral values – what should be done (Finkleman &Kenner, 2016, p. 56). This

physician was an advocate for his patient. It is shown that patients that survive cardiac arrest that

is experienced outside of the hospital have a potential for improving outcomes by early

revascularization (Camuglia, Randhawa, Lavi, & Walters, 2014, p. 1533). The physician knew

that his patient had no chance of living without the catheterization, and he chose to provide care

to her.

A mortality and metrics meeting is designed to discuss safety and implement new

practices that could increase safety. As mentioned above, an attendee of the meeting asked why

an echocardiogram had not been ordered before the patient went to the catheterization lab.

Regarding safety, having the echocardiogram could have prevented the doctor from taking the

patient to the catheterization lab, but it also would have meant that the patient would have

increased risk of death because of the blockage in her heart.

Application to Profession of Nursing

A mortality and metrics meeting is relevant to the profession of nursing because nurses

are involved in the meeting. The nurses are welcome to participate in the open discussion during
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the presentation of the cases. This meeting enhances the importance of inter-professional

communication. Collaboration is a complex process that builds on communication (Black, 2017,

p.250). Inter-professional collaboration is essential for a good patient outcome. Successful

collaboration entails multiple steps: identification of those who have stake in the outcome,

identification of the problem to be solved, identification of barriers to creating a solution,

clarification of the desired outcomes, clarification of the process, identification of who will be

responsible for each step, and evaluation (Black, 2017, p. 251-252). The mortality and metrics

meeting is the bridge between inter-professional communication and inter-professional

collaboration.

Reflection

The mortality and metrics meeting that I attended was very interesting. I was welcomed

in the meeting, and the nurses from the catheterization lab even encourage me to ask questions if

I had any. The only case that was presented that day was an ethical case. The patient was going

to die without revascularization, but there was also a very good possibility that the patient would

die during the procedure. By law clinicians are required to complete revascularization in a

certain amount of time; however, the time stops if there is a need for more information about the

patient. The cardiothoracic surgeon brought up a good point about the ejection fraction because

that information could have guided the physician to decide whether to take the patient to the

catheterization lab at that time, but it is also possible to get a rough estimate of an ejection

fraction during the catheterization procedure. The meeting was extremely eye-opening about the

reality of ethical dilemmas. After the meeting, I realized that nurses really do make a difference

in their workplace. Any concerns about a case can be discussed in a mortality and metrics

meeting. Nurses in the catheterization lab are hands-on in each case and have input on what will
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or will not work. During the meeting, I learned that ethical dilemmas happen during a nursing

career. I will keep in mind that it is extremely important to evaluate my values and know what I

will do and will not do.

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References

Black, B. P. (2017). Professional nursing: Concepts & challenges (8th ed.). St. Louis, MO:

Elsevier.

Camuglia, A. C., Randhawa, V. K., Lavi, S., & Walters, D. L. (2014). Cardiac catheterization is

associated with superior outcomes for survivors of out of hospital cardiac arrest: Review

and meta-analysis. Resuscitation, 85(11), 1533-1540.

doi:10.1016/j.resuscitation.2014.08.025

Finkelman, A. W., & Kenner, C. (2016). Professional nursing concepts: Competencies for

quality leadership (2nd ed.). Burlington, MA: Jones & Bartlett Learning.