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Implementation of a structured hospital-wide morbidity and mortality rounds model
  1. Edmund S H Kwok1,
  2. Lisa A Calder1,2,
  3. Emily Barlow-Krelina2,
  4. Craig Mackie2,
  5. Andrew J E Seely3,
  6. A Adam Cwinn1,
  7. James R Worthington1,
  8. Jason R Frank1,4
  1. 1Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
  4. 4Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
  1. Correspondence to Dr Edmund S H Kwok, Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9; ekwok{at}toh.on.ca

Abstract

Importance There is a paucity of literature on the quality and effectiveness of institutional morbidity & mortality (M&M) rounds processes.

Objective We sought to implement and evaluate the effectiveness of a hospital-wide structured M&M rounds model at improving the quality of M&M rounds across multiple specialties.

Design, setting, participants We conducted a prospective interventional study involving 24 clinical groups (1584 physicians) at a tertiary care teaching hospital from January 2013 to June 2015.

Intervention We implemented the published Ottowa M&M Model (OM3): appropriate case selection, cognitive/system issues analyses, interprofessional participation, dissemination of lessons and effector mechanisms.

Main outcomes and measures We created an OM3 scoring index reflecting these elements to measure the quality of M&M rounds. Secondary outcomes include explicit discussions of cognitive/system issues and resultant action items.

Results OM3 scores for all participating groups improved significantly from a median of 12.0/24 (95% CI 10 to 14) to 20.0/24 (95% CI 18 to 21). An increased frequency of in-rounds discussion around cognitive biases (pre 154/417 (37%), post 256/466 (55%); p<0.05) and system issues (pre 175/417 (42%), post 259/466 (62%); p<0.05) were reported by participants via online surveys postintervention, while in-person surveys throughout the intervention period demonstrated even higher frequencies (cognitive biases 1222/1437 (85%); system issues 1250/1437 (87%)). We found 45 action items resulting directly from M&M rounds postintervention, compared with none preintervention.

Conclusions and relevance Implementation of a structured model enhanced the quality of M&M rounds with demonstrable policy improvements hospital wide. The OM3 can be feasibly implemented at other hospitals to effectively improve quality of M&M rounds across different specialties.

  • Morbidity and mortality rounds
  • Hospital medicine
  • Healthcare quality improvement

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