Background: Mortality and morbidity (M&M) rounds have traditionally been held to allow physicians to discuss adverse events and medical errors. In our hospital, M&M rounds are conducted by individual departments, selected from mortality cases and discussions are centred around a diagnosis or topic. There is increasing recognition that this is a missed opportunity for teaching system-based practice, improving patient safety and educating physicians and residents on cognitive errors. The Ottawa M&M Model (OM3) has been described in the literature as a guide to enhancing M&M rounds.
Purpose: With the aims of improving critical analysis of adverse events, educating physicians on system and human factors in our department, our team decided to adopt elements of the OM3.
Description: Key components of OM3 include (1) Appropriate Case Selection, (2) Structured Case Analysis, (3) Creation and Dissemination of Bottom Lines, (4) Development of Effector Pathway for Action Items, and (5) Inter-professional and Multidisciplinary Involvement.Since 2016, a team was formed to select appropriate cases for discussion. Efforts were made to choose cases with an adverse event that are potentially preventable, and cases with system issues or cognitive bias. Other than mortality cases, we also tried to identify near misses, cases highlighted in the risk management system, patient complaints and cases that frustrate physicians. While it was ideal for presenters to present cases that they were involved in, most of the faculty members had difficulty selecting one. The M&M team then chose a suitable case for discussion.From 2017, a template and guide for M&M were developed. This was deemed necessary as most physicians are unfamiliar with system and human factors. Residents were introduced to cognitive bias and tools like incident mapping and 5-Whys to aid their analysis. To assess improvements in M&M discussions, we decided to assess the M&M rounds using the adapted OM3 score. As we were assessing the impact of the template, we only counted scores for case analysis, reach, impact and outcomes. Over a 1-year period, the scores improved from 7 to 9.3, out of a maximum of 12. Despite the improvements made to M&M rounds, it is still far from ideal. The main benefits observed are in improvements in system-based practice education. As this is an initiative within a single department, channels for lessons to be disseminated to a wider audience in the hospital are still lacking. There is also no process to rectify system issues identified. To make system-wide changes, institutional support will then be required.
Conclusions: Here, we describe our efforts in adopting OM3 to improve M&M rounds in our department. It has improved discussions in our M&M rounds. To have a greater impact on patient safety, institutional support will be crucial to help disseminate lessons and make system-wide improvements.