Introduction
Surgical morbidity and mortality (M&M) meetings are used to learn from clinical outcomes and drive continued improvements in service delivery. The Royal College of Surgeons of England (RCSEng) provides national standards for surgical M&M meetings which form the basis of this closed loop audit.

Aims
The aim of this study is to audit current departmental practice relative to evidence-based RCSEng national guidance and implement change to improve quality of urology M&M meetings at our centre.

Methods
Cycle 1
Departmental M&M meetings from September - November 2018 were prospectively reviewed and assessed for: the availability of administrative support, formal registration, minuting, the use of a standardised presentation format (Clavien-Dindo classification) and the application of NCEPOD standard of care grading system.

Intervention
Departmental administrative staff were allocated time to support the running of the M&M meeting. Standardised presentation slides were developed and structured according to the Clavien-Dindo classification of adverse surgical outcomes and the NCEPOD outcome system.

Cycle 2
M&M meetings were prospectively re-audited following intervention between January and February 2019.

Results
The implementation of the above interventions improved the rates of formal registration, standardised classification, minuitng and implementation of NCEPOD standard of care grading to 100% compliance with national standard.

Conclusions and recommendations
Simple interventions, alongside adequate administrative support, ensure structured departmental M&M meetings. This provides an optimal environment to discuss adverse surgical outcomes and instigate change. We recommend the allocation of administrative staff time to the running of departmental meetings and the use of standardised presentation slides.









Introduction
Surgical morbidity and mortality