Implementation of a structured
hospital-wide morbidity and mortality
rounds model

TOH-EK-Structured M&M Model

The Ottawa Hospital

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.


Authors: Edmund S H Kwok, Lisa A Calder, Emily Barlow-Krelina, Craig Mackie, Andrew J E Seely, A Adam Cwinn, James R Worthington, Jason R Frank

Edmund S H Kwok - ekwok@toh.ca

Project complete