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Wu JH, Lee KT, Cheng KI, Du JK, Lee CY. Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model. BMC Oral Health 2024; 24:120. [PMID: 38254042 PMCID: PMC10801931 DOI: 10.1186/s12903-024-03853-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
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.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kun-Tsung Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Je-Kang Du
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Diakonoff H, De Rocquigny G, Tourtier JP, Guigon A. Medicolegal issues of peri-anaesthetic dental injuries: A 21-years review of liability lawsuits in France. Dent Traumatol 2022; 38:391-396. [PMID: 35639817 PMCID: PMC9539868 DOI: 10.1111/edt.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Background/Aim Peri‐anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico‐legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico‐legal issues of PDI‐related liability lawsuits in France. Material and Methods A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri‐operative care, dental injuries, and convictions were collected when available for analysis. Results Twenty‐four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation‐adjusted Euros) excluding legal fees. Conclusions The analysis of PDI‐related liability lawsuits shows that medico‐legal issues differ from those of PDI‐related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI‐risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia‐related damages.
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Affiliation(s)
- Hadrien Diakonoff
- Université Paris Cité, Faculté de santé, UFR d'odontologie, Montrouge, France.,Service de médecine bucco-dentaire, hôpital Henri Mondor, Créteil, France.,Institut droit et santé, INSERM UMR_S 1145, Université de Paris, Paris, France
| | - Gaël De Rocquigny
- Service d'anesthésie-réanimation, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Jean-Pierre Tourtier
- Service d'anesthésie-réanimation, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Aurore Guigon
- Service d'odontologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
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Dental injury associated with anaesthesia: An 8-year database analysis of 592 claims from a major French insurance company. Anaesth Crit Care Pain Med 2017; 37:49-53. [PMID: 28838826 DOI: 10.1016/j.accpm.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dental injury is the most common incident associated with anaesthesia. Regarding recent recommendations on informed consent and changes in airway management practices, a large series of claims related to dental injury has not been recently described. The aim of this study was to analyse a recent database in order to describe the characteristics of dental injury in France. METHODS A database that prospectively collected claims reported to Le Sou Médical-MACSF between January 2003 and December 2010, was analysed. Five hundred and ninety-two cases were reported. The following characteristics were analysed: number and type of teeth injured, mechanism of injury, anaesthetic procedure, risk factors and dental outcome after injury. RESULTS Amongst the 1514 claims related to anaesthesia, 592 (39.2%) were classified as dental damage. Preoperative informed consent concerning possible perioperative dental injury was documented in only 34.8% of patients. Only one tooth was affected in 65.2% of patients, dental bridge injury in 12.8% of cases and damage to two or more teeth in 14% of patients. Incisors were involved in 50% of cases. Fracture was the most common type of injury (64.2%). Poor dentition was the most common risk factor (23.1%) followed by difficult intubation (15.4%). Both risks were combined in only 7.6% of cases. Tracheal intubation was the highest risk procedure (41.6%). CONCLUSION Dental injury remains the most common anaesthesia-related claim. Dental examination and documentation in patient medical files requires improvement and better informed consent on dental injury risk needs to be provided to patients.
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. [Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]. Rev Bras Anestesiol 2016; 67:6-14. [PMID: 27692805 DOI: 10.1016/j.bjan.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Espanha
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madri, Espanha; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madri, Espanha
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Espanha; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madri, Espanha
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Espanha
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha.
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Boutonnet M, Trouiller P, Lopard E, Amalberti R, Houselstein T, Pasquier P, Auroy Y, De Saint-Maurice G. Insurance statements from French anaesthesiologists and intensivists: A database analysis. Anaesth Crit Care Pain Med 2016; 35:313-321. [PMID: 27432614 DOI: 10.1016/j.accpm.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/15/2015] [Accepted: 11/27/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND From its origins, anaesthesia is a leading medical specialty for improving patient safety. However, perioperative adverse events remain frequent and may be preventable in 50% of cases. We conducted a collaborative retrospective study analysis of the insurance-database of the MACSF-Sou Medical insurance company to assess the perioperative risk. MATERIAL AND METHODS Retrospective study, including all the statements declared by anaesthesiologists to the MACSF-Sou Medical insurance company. A description of risk in perioperative medicine was performed by the assessment of these statements by three experts member of the SFAR. All the statements concerning regional anaesthesia and dental injuries were excluded. RESULTS Eight hundred and seventy statements were analyzed. The patients involved were predominantly women (sex-ratio: 0.86), with a mean age of 56 years (±18). Three hundred and fifteen cardiac arrests, 157 severe systemic complications, 340 moderate complications and 106 conflicts were analyzed. Most of the events were revealed postoperatively (79.3%) and almost half of them after the discharge of the postanesthetic care unit. The medical consequences were considered as serious. Death followed 35.9% of the events declared. Relative or true hypovolaemia and stroke were responsible for a large part of postoperative mortality and morbidity. CONCLUSION Collaborating with insurance companies allows a relevant approach of the perioperative risk. The study highlighted the importance of the delayed complications and is a plea for a more intense implication of anaesthesia in the postoperative care with the aim of improving patient safety.
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Affiliation(s)
- Mathieu Boutonnet
- Department of anaesthesiology and intensive care unit, Percy military teaching hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - Pierre Trouiller
- Intensive care unit, Antoine-Béclère university hospital, 157, rue de la Porte-de-Trivaux, Clamart, France
| | - Eric Lopard
- MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France
| | - René Amalberti
- MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France
| | - Thierry Houselstein
- MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France
| | - Pierre Pasquier
- Intensive care unit, Begin military teaching hospital, 69, avenue de Paris, Saint-Mandé, France
| | - Yves Auroy
- Hospital and research division, head office of military health service, direction centrale du service de santé, Fort-Neuf de Vincennes, cours des Maréchaux, Vincennes, France
| | - Guillaume De Saint-Maurice
- Department of anaesthesiology and intensive care unit, Val-de-Grâce military teaching hospital, 74, boulevard de Port-Royal, Paris, France
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation. Braz J Anesthesiol 2016; 67:6-14. [PMID: 28017172 DOI: 10.1016/j.bjane.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Spain
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madrid, Spain; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Spain; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madrid, Spain
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Spain
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain.
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Brandão Ribeiro de Sousa JM, de Barros Mourão JI. Tooth injury in anaesthesiology. Braz J Anesthesiol 2015; 65:511-8. [DOI: 10.1016/j.bjane.2013.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND AND OBJECTIVES Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.
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