International Urology and Nephrology

, Volume 50, Issue 5, pp 929–938 | Cite as

Implementation and evaluation of structured nephrology morbidity and mortality conferences: a quality education report

  • Pierre Antoine Brown
  • Swapnil Hiremath
  • Edward G. Clark
  • Edmund S. H. Kwok
  • Christopher McCudden
  • Ayub Akbari
Nephrology - Original Paper



Morbidity and Mortality Conferences (M&MCs) have for generations been part of the education of physicians, yet their effectiveness remains questionable. The Ottawa M&M Model (OM3) was developed to provide a structured approach to M&MCs in order to maximize the quality improvement impact of such rounds.

Study design

We conducted a retrospective assessment of the impact of implementing nephrology-specific M&MCs using the OM3.

Setting and participants

All physicians, residents and fellows from the division of nephrology at a large academic medical center were invited to participate.

Quality improvement plan

Structured M&MCs were implemented to identify preventable errors and generate actions to improve quality of care and patient safety.


Number and nature of cases reviewed, number and nature of recommendations generated through identification of preventable health system and/or cognitive factors.


Morbidity and/or mortality in each case were identified. A determination of the underlying factors and preventability of these events was made. A qualitative review of resulting recommendations was performed.


Over the course of sixteen 1-h long conferences, 52 cases were presented. For all cases presented, discussion, action items and information dissemination followed the OM3. As a result of the M&MCs, 29 recommendations (emanating from 27 cases) lead to improve care delivery.


Limitations of this study include its retrospective nature and single-center design.


The implementation of regularly scheduled M&MCs at an academic nephrology program, using a structured model, identified preventable health-systems issues and cognitive errors. Approximately one-half of the cases reviewed generated actions for health care delivery improvement.


Healthcare quality improvement Morbidity and mortality rounds Medical education Patient safety 



The authors wish to thank all the physicians, residents and trainees of the nephrology program at the Ottawa Hospital who contributed to the success of the M&MCs.

Author contributions

Research idea and study design: PAB, SH, AA; data acquisition: PAB, AA, SH; data analysis/interpretation: PAB, SH, CM, AA, EC; supervision and mentorship: ESHK, EC. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.


This study was not supported by external funding. SH, AA and EC receive research salary support from the Department of Medicine, University of Ottawa.

Compliance with ethical standards

Conflict interest

The authors report no conflict interests.

Supplementary material

11255_2018_1842_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nephrology, Department of MedicineUniversity of OttawaOttawaCanada
  2. 2.Kidney Research CentreOttawa Hospital Research InstituteOttawaCanada
  3. 3.Department of Emergency MedicineUniversity of OttawaOttawaCanada
  4. 4.Division of BiochemistryThe Ottawa HospitalOttawaCanada
  5. 5.Division of NephrologyThe Ottawa HospitalOttawaCanada

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