Psychiatry morbidity and mortality rounds: implementation and impact

Area of Science:

• Child and Adolescent Psychiatry
• Medical Education
• Patient Safety

Background:

• Psychiatry morbidity and mortality rounds (M&Ms) are crucial for quality improvement.
• Implementing M&Ms in pediatric settings requires specific considerations for clinical and educational impact.

Purpose of the Study:

• To assess the implementation and impact of psychiatry morbidity and mortality rounds (M&Ms) on clinical and educational practices.
• To evaluate the effectiveness of M&Ms in a children's hospital setting.

Main Methods:

• Monthly M&Ms were conducted from July 2005 to May 2007, involving multidisciplinary staff and trainees.
• Cases were selected using a priori risk criteria and rated on a four-level risk management scale.
• M&Ms were analyzed for recurrent patterns contributing to adverse patient care, and attendees evaluated educational value via surveys.

Main Results:

• Opportunities for patient care improvement were identified in 80% of reviewed cases.
• Common areas for improvement included diagnostic/formulation errors, communication issues, system-based problems, and cultural misunderstandings.
• Corrective actions based on M&M findings led to positive changes in patient care.

Conclusions:

• Morbidity and mortality rounds (M&Ms) serve as a valuable platform for self-appraisal and case review in psychiatry.
• M&Ms can significantly aid psychiatry programs in enhancing patient safety and advancing clinician education.