@article {Kwok439, author = {Edmund S H Kwok and Lisa A Calder and Emily Barlow-Krelina and Craig Mackie and Andrew J E Seely and A Adam Cwinn and James R Worthington and Jason R Frank}, title = {Implementation of a structured hospital-wide morbidity and mortality rounds model}, volume = {26}, number = {6}, pages = {439--448}, year = {2017}, doi = {10.1136/bmjqs-2016-005459}, publisher = {BMJ Publishing Group Ltd}, 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.}, issn = {2044-5415}, URL = {https://qualitysafety.bmj.com/content/26/6/439}, eprint = {https://qualitysafety.bmj.com/content/26/6/439.full.pdf}, journal = {BMJ Quality \& Safety} }