Implementation of a Structured Hospital-wide Mortality and Morbidity Rounds Model: An Interventional Study
Patient Safety and Quality of Care
Currently, most hospitals hold regular educational exercises where they discuss cases with unexpected outcomes, called Morbidity & Mortality rounds. To date, these are unstructured and as such, constitute missed opportunities for improving patient safety and quality of care. Through this project, we successfully implemented the previously published Ottawa Morbidity & Mortality rounds Model (OM3) to 16 clinical groups at The Ottawa Hospital. This model was adopted by surgical and non-surgical divisions, the Department of Pharmacy, and Internal Medicine residents at two academic campuses. All groups demonstrated improvements in case selection and analysis, as well as increases in the perceived impact of M&M rounds on individual and departmental practices. In addition, we observed that this initiative helped several divisions to enhance their quality improvement processes.
Morbidity & Mortality (M&M) Rounds have long been identified as a forum for the discussion of preventable errors, and a potential mechanism for addressing them. To date, there have been few published guidelines as to how such rounds should be conducted. We previously published a novel structured M&M rounds model, the OM3, but there has been no formal evaluation of its effectiveness across multiple specialities. We evaluated the implementation of a structured M&M rounds model in a tertiary care teaching hospital. We recruited 23 departments/divisions of The Ottawa Hospital (TOH) to participate in our before and after study. We had 17 intervention groups and 6 controls. The intervention included an initial education session, distribution of a guiding document, and dissemination of a template for those presenting at rounds. We used the following measurement tools to evaluate effectiveness: needs assessment interviews; online surveys; paper surveys distributed during M&M Rounds; and audit of policy items arising from the rounds. We assigned an overall OM3 index score to each participating group as a summary measure of M&M rounds quality before and after implementation. Of the 17 intervention groups (4 surgical, 13 medical), we observed the following increases on a 5 point Likert scale: case selection: 2 (± 2) to 3 (± 0; P = 0.002); case analysis: 1 (± 0) to 3 (± 0; P < 0.0001); and M&M Round reach: 2 (± 0) to 3 (± 1; P < 0.0001). The OM3 index score also showed a hospital-wide increase, with an average score of 11.2 (± 6.1) pre-intervention, and 20.4 (±2.0; P < 0.0001) post-intervention. We demonstrated significant impact of the OM3 to enhance the quality of M&M rounds.