Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Medicine, Western University, London, Ontario, Canada.
BMJ Qual Saf. 2018 Jan;27(1):74-84. doi: 10.1136/bmjqs-2017-006632. Epub 2017 Sep 29.
The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals.
Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically.
The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research.
These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds.
质量和安全运动重新激发了优化发病率和死亡率（M&M）会议的兴趣。我们进行了系统评价，以确定有效方法来更新 M&M 会议，以（1）发现和解决质量和安全问题，（2）解决当代教育目标。
搜索相关数据库（Medline、Embase、PubMed、教育资源信息中心、护理和相关健康文献累积索引、Healthstar 和全球健康）以确定原始来源。如果研究（1）调查应用于 M&M 会议的干预措施，（2）报告与识别质量和安全问题相关的结果，或与质量改进（QI）、患者安全或一般医学教育相关的教育结果，（3）包括对照组，则纳入研究。使用医学教育研究研究质量工具和纽卡斯尔-渥太华量表-教育工具评估研究质量。鉴于干预措施和结果测量的异质性，对结果进行了主题分析。
最终分析包括 19 项研究。我们确定了多种有效的策略（更新目标、标准化会议的要素并将会议与正式的质量委员会联系起来），以优化 M&M 会议的质量和安全目的。这些努力与成功地将质量和安全内容融入会议以及增加 QI 干预措施的实施有关。由于采用的方法不适合教育研究，因此难以确定对教育结果的一致影响。
对于那些寻求优化 M&M 会议的质量和安全任务的人来说，这些结果令人鼓舞。然而，无法确定一致的教育效果表明，对 M&M 会议的调查可能需要额外的方法（定性、混合方法），以便了解推动 M&M 会议学习的复杂机制。
