Implementation of a Structured Morbidity and Mortality Rounds on an Internal Medicine Clinical Teaching Unit A Quality Improvement Project
Main Article Content
Keywords
quality improvement, patient quality and safety, medical education, internal medicine, morbidity and mortality
Abstract
Morbidity and mortality rounds (MMRs) are widely used in a variety of medical settings; however, their implementation and quality are highly variable. In this quality improvement project, we implemented the Ottawa Morbidity and Mortality Model (OM3) at a quaternary teaching hospital inpatient internal medicine clinical teaching unit (CTU). We assessed adherence to the model using a locally developed scale and surveyed participants regarding acceptability of the change. We used several measures to improve adherence, including regular involvement of allied health professionals, screening of cases for appropriateness, providing a template to the residents who prepare cases for presentation, and limiting the number of presentations at each session. Adherence to OM3 improved over time and was consistently high by the end of our data-collecting period. The intervention was also widely accepted by participants, and rounds were found to be valuable to participants. Implementing a validated, structured format, such as OM3, can improve the quality of MMRs while being accepted by participants in an internal medicine teaching hospital.
Résumé
Les revues de morbidité et mortalité (RMM) sont largement utilisées dans divers contextes médicaux, mais leur mise en œuvre et leur qualité varient considérablement. Dans ce projet d’amélioration de la qualité, nous avons implanté l’Ottawa Morbidity and Mortality Model (OM3) dans une unité d’enseignement clinique (UEC) de médecine interne en milieu hospitalier universitaire de soins quaternaires. Nous avons évalué l’adhésion au modèle à l’aide d’une échelle conçue localement et interrogé les participants sur l’acceptabilité de ce changement. Nous avons utilisé plusieurs mesures pour améliorer l’adhésion, notamment la participation régulière de professionnels paramédicaux, la vérification de la pertinence des cas, la fourniture d’un modèle aux résidents qui préparent les cas à présenter et la limitation du nombre de présentations de cas à chaque séance. L’adhésion à l’OM3 augmente au fil du temps et est toujours élevée à la fin de notre période de collecte des données. Cette intervention est aussi largement acceptée par les participants, et les revues se sont révélées précieuses pour les participants. La mise en œuvre d’un format structuré et validé comme l’OM3 peut améliorer la qualité des RMM tout en étant acceptable pour les participants en médecine interne dans un
hôpital universitaire.
References
2. Calder LA, Kwok ESH, Adam Cwinn A, et al. Enhancing the quality of morbidity and mortality rounds: The Ottawa M&M model. Acad Emerg Med. 2014 Mar;21(3):314–21. https://doi. org/10.1111/acem.12330
3. Katz D, Detsky AS. Incorporating metacognition into morbidity and mortality rounds: The next frontier in quality improvement: Metacognition to reduce medical error. J Hosp Med. 2016 Feb;11(2):120–2. https://doi.org/10.1002/jhm.2505
4. Epstein NE. Morbidity and mortality conferences: Their educa-tional role and why we should be there. Surg Neurol Int. 2012;3 (Suppl 5):S377-88. https://doi.org/10.4103/2152-7806.103872
5. Kwok ESH, Calder LA, Barlow-Krelina E, et al. Implementation of a structured hospital-wide morbidity and mortality rounds model. BMJ Qual Saf. 2017 Jun;26(6):439–48. https://doi.org/10.1136/bmjqs-2016-005459
6. Wong BM, Etchells EE, Kuper A, Levinson W, Shojania KG. Teaching quality improvement and patient safety to trainees: A systematic review: Acad Med. 2010 Sep;85(9):1425–39. https://doi.org/10.1097/ACM.0b013e3181e2d0c6
7. Benassi P, MacGillivray L, Silver I, Sockalingam S. The role of morbidity and mortality rounds in medical education: A scoping review. Med Educ. 2017;51(5):469–79. https://doi.org/10.1111/medu.13234
8. Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015. Physician competency framework. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; 2015.
9. Royal College of Physicians and Surgeons of Canada. Objectives of training in the specialty of internal medicine. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; 2011.
10. Royal College of Physicians and Surgeons of Canada. Internal medicine competencies. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada; 2018.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles are published under a Creative Commons Attribution - Non Commercial 4.0 International License. Authors and users are free to copy and redistribute the material in any medium or format, with proper attribution, for non-commercial purposes. Authors retain copyright to their article.
Ben Schwartzentruber, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
Department of Internal Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
Penny Tam, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
Department of Internal Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
Allison Chiu, Vancouver Coastal Health Authority, Vancouver, BC, Canada
Vancouver Coastal Health Authority, Vancouver, BC, Canada