Morbidity and mortality (M&M) rounds have been undertaken in most human hospitals and veterinary hospitals for many years, as part of quality improvement efforts for patient safety and systems improvement; as well as, in some countries, compulsory training for medical students. Not only are M&M rounds important for medical education for general medical knowledge, but they are also important for learning about non-technical skills and quality improvement practices. M&M rounds have also been found to be important for developing a safety culture within hospitals.

Every hospital should have a system in place for undertaking M&M rounds, as part of their quality improvement practices and for staff education. Although there are considerable publications on how M&M rounds should be undertaken in human hospitals, literature on M&M rounds in the veterinary literature is limited to one publication for surgical trainees and literature reviews based on human medicine.

However, M&M rounds for veterinary emergency and critical care (ECC) have their own challenges, with high rates of medication-based errors, high mortality rates (e.g., do we round on every CPR case?), and finding the most appropriate time to undertake rounds.

There are key aspects to undertaking successful M&M rounds. These features include:

• Having an M&M committee
• Establishing a common understating of purpose (is it quality improvement, learning, or both?)
• Establishing ground rules (blame free, respect, confidentiality, anonymity, time keeping, attendance)
• Establishing practicalities (when, where, who)
• Appropriate case selection (common cases rather than unique, near miss/death, number of cases)
• Format (examples from the human literature include SBAR, OM3)
• Preparation (template, considering all aspects of the case, support from M&M committee, literature review)
• Effective follow-up of action points

When analysing cases for M&M rounds, it is important to consider and discuss Safety I (what went wrong), and Safety II (what went right). A root cause analysis (RCA) approach can be undertaken to identify active and latent failures (or successes!), with examples of RCA approaches including the Yorkshire Contributory Factors Framework (YCFF) and Fishbone analysis. M&M rounds should be concluded with action points and SMART (specific, measurable, attainable, relevant, and time-based) goals; and a take-home message. After M&M rounds, the presenter should debrief and receive constructive feedback. Quality improvement groups may want to follow up on the action points, and any changes made from the action points communicated to frontline staff and in the next M&M meeting. This lecture will have a panel discussion on how we can develop a protocol for successful M&M rounds in veterinary ECC, what challenges we face as a discipline, and how to overcome these challenges.

References

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