Effectiveness of an Interdisciplinary Medical Hospital Admission Center: The Role of the Dental Section in the Interdisciplinary System for Perioperative Management of Patients Awaiting Surgery

Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model

BACKGROUND

A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model.

METHODS

This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861.

RESULTS

We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (β = -0.074, P = 0.003), responsiveness (β = -0.148, P = 0.006), and empathy (β = -0.140, P = 0.011). Furthermore, reliability (β = 0.655, P < 0.001) and responsiveness (β = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services.

CONCLUSIONS

The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

Periodontal disease in preoperative patients with digestive cancer: a retrospective, single-institution experience in Fukui, Japan

BACKGROUND

The careful preoperative oral assessment may be useful for safe surgery under general anesthesia. The purpose of this study was to investigate the presence of periodontitis in patients with malignant digestive disease before surgery under general anesthesia.

METHODS

Patients with digestive malignant disease who underwent periodontal examination and orthopantomograph examination for preoperative oral health assessment were participated. The authors investigated the patients' general characteristics and clinical oral information, including the presence of periodontitis.

RESULTS

One hundred twenty patients participated in this study. The mean and standard deviation of the number of teeth was 20.8 ± 8.2, and there was a statistically significant correlation between age and number of teeth. The periodontal pocket depth was 3.0 ± 1.0, and mobile teeth were observed in 62 patients. There was a statistically significant correlation between number of teeth and number of mobile teeth. However, there was no significant difference between the age of patients without mobile teeth and the age of patients with mobile teeth.

CONCLUSIONS

This retrospective study performed in single-institution clarified the presence of periodontitis in patients with malignant digestive disease before surgery. Regardless of age, it is important to assess the oral health, including periodontitis, for safe surgery under general anesthesia.

An Avulsed Tooth Detected Prior to Insertion of a Laryngeal Mask Airway

This case report describes the importance of inspecting the hypopharynx via direct laryngoscopy prior to laryngeal mask airway (LMA) insertion during induction of general anesthesia for dental patients with special needs. A 51-year-old man with cerebral palsy underwent induction of general anesthesia for dental extractions and subsequently was noted to be missing a tooth. Prompt inspection of the airway via direct laryngoscopy revealed the tooth resting within the pharynx, which was subsequently retrieved, prior to insertion of the LMA. Visual inspection of the oropharynx and hypopharynx by laryngoscopy prior to LMA insertion can be useful in preventing accidental aspiration and ingestion of foreign bodies, particularly with certain high-risk patients. Use of laryngoscopy should also be considered if an object is lost or possibly impinging upon the airway.