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Psychiatry Morbidity and Mortality Rounds: Implementation and Impact

Received April 30, 2008; revised November 21, 2008; accepted January 6, 2009. Drs. Goldman and Kemler are affiliated with Psychiatry at Children’s Hospital Boston; Dr. DeMaso is affiliated with Psychiatry at Harvard Medical School in Boston. Address correspondence to Stuart Goldman, M.D., Children’ Hospital Boston, Psychiatry, 300 Longwood Ave., Boston, MA 02115; stuart.goldman{at}childrens.harvard.edu (e-mail).

OBJECTIVE: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children’s hospital. METHODS: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a priori risk criteria and each rated on the hospital’s four-level risk management scale. M&Ms were reviewed for recurrent patterns that contributed to adverse patient care. Attendees completed a survey at the end of each year, evaluating the educational value of the rounds. RESULTS: Possible opportunities for patient care improvement were found in 80% of the cases and fell into four overlapping areas: diagnostic/formulation errors, communication problems, system-based problems, and class/culture misunderstandings. Identifying these problems led to corrective actions and positive changes in patient care. CONCLUSION: M&Ms appear to be a potentially productive venue for self-appraisal and case review to aid psychiatry programs in patient safety efforts and clinician education.

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