Developing a Patient Safety System for Dentistry

Objectives: While adverse events in medicine are a major source of preventable death and injury, little is known about patient safety in dentistry. Our goals were to develop the tools necessary to capture adverse events (AEs) in dental patient charts and build a classification scheme and repository to organize them in order to assess and improve the safety of oral healthcare.
Methods: Our Patient Safety Toolkit (PST) was designed to detect dental AEs, defined as “physical harm to a patient due to dental treatment”. We were Inspired by the Institute for Healthcare Improvement's (IHI) global and outpatient trigger tools, which identify records with characteristics ("triggers") that are associated with adverse events. Our PST incorporated: (1) a dental trigger tool and automated electronic health records (EHR) scripts, (2) a chart audit tool, (3) categorization and severity rating adapted to the dental office, and (4) supporting documentation, including a dental AE inventory and training module.

Results: The PST incorporated 11 triggers and found 3,283 charts with potential adverse events. After reviewing a random sample of 859 charts, 92 charts were found to have an AE. Triggers that focused on Infections, Allergies, Failed Implants, Nerve Injury and Post-surgical complications performed well (Positive Predictive Value: 0.29, 0.23, 0.21, 0.19 and 0.16 respectively). Pain was the most frequent AE followed by infection and hard tissue damage. Examples of specific AEs included tooth damage, root canal perforation, bone damage after implant placement, paresthesia, trismus and ingestion of foreign body. Most AEs were temporary in nature.
Conclusions: The PST is a promising approach for detecting dental AEs through electronic patient health records. Ultimately, our goal is to move the dental profession towards a better understanding of the quality and safety issues that exist and how best to tackle them using evidence-based best practices.