Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model

Abstract

Objectives: The objective of this study was to determine the feasibility and acceptability of a structured morbidity and mortality (M&M) rounds model through an innovative educational intervention. Methods:The authors engaged the Departments of Emergency Medicine (EM) and Trauma Services at a tertiary care teaching hospital. A needs assessment was performed; the Ottawa M&M rounds model was developed, implemented, and then evaluated as a four-part intervention. This consisted of: 1) physician training on case selection and analysis, 2) engaging interprofessional members, 3) disseminating lessons learned, and 4) creating an administrative pathway for acting on issues identified through the M&M rounds. The measures of intervention feasibility included the proportion of sessions adherent to the new model and M&M rounds attendance. Pre-and postintervention surveys of presenters and attendees were used to determine intervention acceptability. M&M presentation content was reviewed to determine the most frequently adopted components of the model. Results:Nine of 14 (64.3%) sessions were adherent to three of four components of the Ottawa M&M Model. Of those M&M attendees who responded to the survey (796 of 912, 87.2%), improvements were found in M&M rounds attendance as well as perceived effect on clinical practice at both individual and departmental levels. Thirty-seven case presentations were analyzed and improvements postintervention were found in appropriate case selection and recognition of cognitive and system issues. Conclusions:The Ottawa M&M Model was a feasible intervention that was perceived to be effective by both presenters and attendees. The authors believe that this could be readily applied to any hospital department seeking to enhance quality of care and patient safety.ACADEMIC EMERGENCY MEDICINE 2014; 21:314-321

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

“…We have described the full OM3 approach to M&M rounds in a previous publication 6. In brief (box 1), key features of the OM3 include guidelines on appropriate case selection (a case must have an adverse event, preventability and lessons to be learnt), structured case analysis to specifically identify cognitive biases and system issues, discussion of possible action items, creation and dissemination of the summaries of each discussion, development of explicit administrative pathways to action on identified issues and encouragement of interprofessional and multidisciplinary involvement.…”

“…In our previous work, we described the development of a novel structured model for M&M rounds, the Ottowa M&M Model (OM3) 6. To our knowledge, there has not been any published evidence on the effectiveness of implementing a standardised structured approach to M&M rounds across multiple specialties in a hospital setting.…”

Teaching M&M rounds skills: enhancing and assessing patient safety competencies using the Ottawa M&M model

“…The primary author (SEM) developed a novel M&M rounds case critique tool (see online supplementary appendix A) based on OM3 10. We circulated the tool among four local experts in medical education (JRF), patient safety (LAC) and medical administration (ESHK and AAC) for comment and modification.…”

“…The survey also asked residents to enumerate five types of errors leading to adverse outcomes (as per Cosby et al ,11 table 2), three essential elements of appropriate M&M rounds cases (as per Calder et al 10) and five different types of cognitive errors (as per Campbell et al 12). …”

“…Until recently, there existed no specific guidelines for the content or format for M&M rounds 9. In 2014, Calder et al 10 published the Ottawa Morbidity and Mortality Model (OM3) (figure 1), a model to enhance the quality and impact of M&M rounds using key patient safety principles. The OM3 model is a structured approach to M&M rounds but does not outline how to teach case selection and analysis to medical learners (table 1).…”