title: Implementation of a structured hospital-wide morbidity and mortality rounds model.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We conducted a prospective interventional study involving 24 clinical groups (1584 physicians) at a tertiary care teaching hospital from January 2013 to June 2015.
  
  
  METHODS
  We implemented the published Ottowa M&M Model (OM3): appropriate case selection, cognitive/system issues analyses, interprofessional participation, dissemination of lessons and effector mechanisms.
  
  
  METHODS
  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
  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.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Edmund S H
authors.initials: ESH
authors.lastname: Kwok
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Calder
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Barlow-Krelina
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Mackie
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Andrew J E
authors.initials: AJE
authors.lastname: Seely
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: A Adam
authors.initials: AA
authors.lastname: Cwinn
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: James R
authors.initials: JR
authors.lastname: Worthington
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Frank
mesh_terms: D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008505:Medical Staff, Hospital / Q000193:education*; D009017:Morbidity; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration; D056164:Teaching Rounds / Q000458:organization & administration* / Q000592:standards
keywords: Healthcare quality improvement; Hospital medicine; Morbidity and mortality rounds