Root Cause Analysis for Prevention of Future Dental Adverse Events

Objectives: A dental Adverse Event (AE) is any iatrogenic harm or unforeseen occurrence to the patient during treatment, not caused by the underlying disease or condition. Despite efforts to improve safety, patients sometimes suffer harm in the dental chair. Our objective was to better understand why dental AEs occur and to use root cause analysis (RCA) to identify contributing factors by analyzing patient data in electronic health records (EHRs).
Methods: RCA was performed on 44 AEs previously identified at one academic institution. The types of AEs analyzed were infection, hard tissue damage, soft tissue injury, nerve injury, aspiration/ingestion of foreign object, bleeding, wrong site wrong procedure, allergy/toxicity/foreign body response and pain. We abstracted data from the EHR and placed on a timeline prior to and after the AE. Data were then analyzed through a structured process to determine what happened and why. We coded contributing factors that led to the AE by using the International Classification of Patient Safety (ICPS) provided by WHO, and extended the conceptual model to make a better fit for dentistry.
Results: The EHR contained sufficient data to conduct RCA for 68% (n=30) of the dental AEs. After further analysis, we identified and grouped contributing factors into three categories: 1) provider factors, 2) patient factors and 3) organizational factors. Provider factors accounted for 30% (n=9) of the AEs, 10% (n=3) due to patient factors, 40% (n=12) due to provider and patient factors, 13% (n= 4) due to provider and organizational factors, and 7% (n=2) due to provider, patient and organizational factors. We found that 40% (n= 12) of the AEs could have been prevented.
Conclusions: Root Cause Analysis using data from EHRs is a feasible approach for identifying contributors of AEs. After determining why AEs occur, we can then develop strategies to reduce AEs in dentistry.