Enhancing the Quality of Morbidity & Mortality rounds Hospital-wide: the Ottawa M&M Model (OM3)Kwok ES, Calder LA, Barlow-Krelina E, Seely AJ, Cwinn A, Worthington J, MacKie C, Frank JR

Canada’s Forum on Patient Safety & Quality ImprovementEdmonton AB October 2014Dr. Edmund Kwok: ekwok@toh.on.ca

PROBLEM /OPPORTUNITY

Morbidity & Mortality Rounds (M&MR) traditionally used as potential opportunity for healthcare professionals to review errors and identify issues to be addressed

Recent current state analysis of our institution revealed:

not all Dept/Div held M&MR regularly

for those who did, variable effectiveness in the quality of M&MR discussions and any resulting actions impacting quality of care

We recently published a novel structured approach to M&MR1, but it has not been validated across specialties

1Calder LA, Kwok ES, Cwinn AA, Worthington J, Yelle JD, Waggott, Frank JR. Enhancing the quality of morbidity and mortality rounds: the Ottawa M&M model. Acad Emerg Med. 2014;21(3):314-21

AIMTo implement and evaluate a structured M&MR model across multiple specialties in a tertiary care teaching hospital

Identified M&MR Champions within each participating group

Educational/coaching workshops at beginning and throughout 12-month study period

Implementation of OM3 components:

appropriate case selection

dissemination of lessons learned

development of institutional mechanisms to address identified issues (e.g. establishing Quality Committees)

encourage inter-professional & multidisciplinary involvement

INTERVENTION

MEASUREMENT

1. Needs assessment Interviews & Exit Interviews with M&MR Champions

2. Before/After Web Surveys of M&MR participants

3. In-person participant Paper Surveys during M&MRs

4. Policy audit of Quality Committees and/or other relevant institutional mechanism for action items arising from M&MRs

Overall “OM3 Score” (Total=24)

RESULTS: HOSPITAL-WIDESignificant improvement in:

Improvement needs addressedImpact -cognitiveImpact - system

Overall OM3 Score improved from 11 to 21Significant increase in policy action items to address issues arising out of M&MRs

Figure 1: Before/After Web Survey Results on 5-Point Likert Scale

Figure 3: Before/After Overall OM3 Score Figure 2: Before/After Participant Rating on M&MRs Effectively Addressing

Cognitive/System Issues

RESULTS: SURGICAL vs NON-SURGICAL

There were significant cultural differences between these 2 groups on how M&MRs functioned

e.g. Trainees/Residents uniformly presented M&MR cases in Surgical groups, whereas a more even mix of Residents/Staff Physicians presented for Non-Surgical Groups

Regardless, significant improvement in M&MRs for both groups

Figure 4: Before/After OM3 Scores for Surgical Groups (N=5)

(Statistically significant improvements in Case Selection, Case Analysis and Outcomes)

Figure 5: Before/After Scores for Non-Surgical Groups (N=12)

(Statistically significant improvement in all domains except for Frequency of Rounds)

CONTRIBUTION TO PATIENT SAFETY AND QUALITY OF CARE

We demonstrated a successful implementation of a structured M&MR model across various specialtiesThe OM3 intervention led to a hospital-wide improvement in the quality of M&MR discussions and the number of quality improvement actions in response to issues arising out of these roundsOur experience shows that this practical model can be easily adopted at any hospital/institutionThis has implications for patient safety culture and the reduction of adverse events across different medical and surgical specialties

LESSONS & SUSTAINABILITY

Alignment with corporate strategy and recruitment of Champions are critical for success of hospital-wide quality improvement initiativesContinuous refinement of interventions to cater to the specific needs of individual groups is essential• We are in the process of developing a Surgical-Specific OM3 model

to address fundamental differences in their approach to M&MRsRegular feedback to participants on progress can act as powerful reinforcements for sustained improvements• We are currently providing summary Report Cards for each

participating Dept/Div to showcase their progress in relation to the rest of the hospital