@article{2003,
  keywords = {Healthcare quality improvement, Hospital medicine, Morbidity and mortality rounds},
  author = {Edmund S H Kwok and Lisa A. Calder and Emily Barlow-Krelina and Craig Mackie and Andrew J E Seely and Adam Cwinn and James R. Worthington and Jason R. Frank},
  title = {Implementation of a structured hospital-wide morbidity and mortality rounds model.},
  abstract = {<p><b>IMPORTANCE: </b>There is a paucity of literature on the quality and effectiveness of institutional morbidity & mortality (M&M) rounds processes.</p><p><b>OBJECTIVE: </b>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.</p><p><b>DESIGN, SETTING, PARTICIPANTS: </b>We conducted a prospective interventional study involving 24 clinical groups (1584 physicians) at a tertiary care teaching hospital from January 2013 to June 2015.</p><p><b>INTERVENTION: </b>We implemented the published Ottowa M&M Model (OM3): appropriate case selection, cognitive/system issues analyses, interprofessional participation, dissemination of lessons and effector mechanisms.</p><p><b>MAIN OUTCOMES AND MEASURES: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS AND RELEVANCE: </b>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.</p>},
  year = {2017},
  journal = {BMJ Qual Saf},
  volume = {26},
  pages = {439-448},
  month = {06/2017},
  issn = {2044-5423},
  doi = {10.1136/bmjqs-2016-005459},
  language = {eng},
}