Morbidity-Mortality Reviews (MMR)

The mortality and morbidity process and meetings are a retrospective peer review of death or morbidity cases with systemic analysis of care provided. The case selection is based on safety incidents, which resulted in moderate to severe harm, or near misses, where patients could have been harmed. The purpose is a collective learning, the implementation of relevant actions for care quality and safety improvement.

To benefit from these meetings, the process has to be a blame-free but a professionally accountable forum to understand and learn about these issues. The focus is on learning and improvement of systems and processes of care and not on individual performance.


Taking over the MMR of DHU Risks in Pregnancy, the FHU PREMA organizes a morbidity and mortality meeting with their 5 perinatal centers’professionals (gynecology-AMP, obstetrics, neonatology) twice a year. Each time, two detailed reviews of clinical records are presented and, at least, one case bears upon prematurity or a theme of the FHU PREMA. In turn, all centers are requested to present a case.

LIdentification and preparation of FHU PREMA MMR

The medical commission of the FHU PREMA is in charge to select the cases and of preparation for discussion and supervision of the systemic analysis. A senior doctor (or midwife), in the same medical specialty and same unit as that responsible for the patient’s care, is appointed to pilot investigations and presentation.

The MMR meeting

All clinicians, doctors in training, midwives and healthcare staff are encouraged to attend the meetings, particularly those involved in patient care cases. An attendance sheet is held. At the meeting day, the senior doctors present the cases and the preliminary analysis. All participants discuss underlying causes and relevant actions to implement. Une feuille de présence est tenue.

Following the MMR

A report of the analysis and suggested actions is drawn and at the disposal of the participants. A certification of attendance could be issued if requested of the FHU PREMA coordination (mail address here). Any attending an MMR is bound by professional secrecy (article L. 1110-4 du Code de la santé publique et article 226-13 du Code pénal).
Each pilot is responsible of following the implementation of actions. At the next meeting, a reporting on the actions taken is expected from the team concerned.

Les RMM de la FHU PREMA contribuent à la pratique de ces revues mais ne remplacent pas les RMM menées dans chaque service au plus près du terrain. Voir le dispositif en place à la maternité de Louis Mourier :