Medical Lead, Clinical Cardiology, St. Paul’s Hospital
Morbidity and Mortality (M&M) Rounds are an excellent platform for clinicians to review colleagues’ cases and learn from their experiences. But to be effective, they require engagement, thoughtful case selection, and a plan for disseminating the learning outcomes.
In 2006, M&M Rounds at the Providence Health Care Heart Centre were held up to twice a month, and attendance by cardiologists was erratic. Cases were randomly selected for presentation and engagement by physicians was low; non-physicians were not even encouraged to attend. Then Eve was appointed Chair of M&M Rounds, and she saw an opportunity to improve engagement and learning at the Heart Centre.
Eve identified the need for a more structured review of an increased number of cases with a broader focus. With that in mind, she invited a cardiovascular surgeon and second cardiologist to join her in her work. She focused on creating an administrative framework for actioning recommendations, and creating a dissemination plan for lessons learned.
With dedication and leadership, she expanded rounds to a weekly format with a focus on evidence-based patient outcomes. The discussion includes representatives from a broad spectrum of health care professionals. To enrich the dialogue, outside guests are brought in to participate, and these special guest-star events draw an increase in attendance from across various disciplines. In addition, subspecialty groups from within cardiovascular sciences present clinical outcomes in this forum once a year. Eve facilitates the discussions and ensures that all attendees are given the opportunity to participate.
The rounds provide a forum for collaboration on clinical reasoning in complicated and challenging cases that is then disseminated to the rest of the clinical teams and can be applied to the next challenges that are encountered. They are complemented by defined action items for follow up and shared learning. As a result, M&M Rounds have provided a significant impetus for building a stronger safety and quality structure within the Heart Centre. They have helped to systematize and standardize clinical and administrative processes, and improve clinical care quality and productivity.
Eve’s oversight of M&Ms has enabled residents, nurses and administrators to join physicians in bringing forward cases for discussion. Any member of the Heart Centre can put forth the name of a patient who has suffered an adverse outcome or presented a challenging system issue during his or her care in the Heart Centre. After the case is abstracted (usually with the help of a cardiology fellow) it is presented to Heart Centre members. Participants are encouraged to discuss the cases in an open and respectful way and target potential areas for improved patient care.
Eve has inspired the Heart Centre teams to think differently and collaborate, and her willingness to raise tough questions has inspired change and improvement. As a result of her effort, vision and commitment, the M&M Rounds have created a robust quality safety framework within the Heart Centre and have improved patient care and outcomes.