Implementation and evaluation of structured nephrology morbidity and mortality conferences: a quality education report
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.
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.
KeywordsHealthcare 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.
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
The authors report no conflict interests.
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