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Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review
  1. Andrew Smaggus1,2,
  2. Marko Mrkobrada2,
  3. Alanna Marson3,4,
  4. Andrew Appleton2
  1. 1 Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  2. 2 Department of Medicine, Western University, London, Ontario, Canada
  3. 3 Hospital Library & Archives, Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4 Health Sciences Library, London Health Sciences Centre, London, Ontario, Canada
  1. Correspondence to Dr Andrew Smaggus, Department of Medicine, Queen’s University, Kingston, Ontario, Canada; andrew.smaggus{at}


Background The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals.

Methods Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically.

Results The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research.

Conclusions These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds.

  • morbidity and mortality rounds
  • patient safety
  • healthcare quality improvement
  • medical education

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  • Twitter Follow Andrew Smaggus @ACSmaggus and Andrew Appleton @AJEAppleton

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.