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Renouard F, Renouard E, Rendón A, Pinsky HM. Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors. Periodontol 2000 2023; 92:382-398. [PMID: 37183608 DOI: 10.1111/prd.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/06/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023]
Abstract
Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.
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Affiliation(s)
| | - Erell Renouard
- Intercampus Affairs, Assistant Dean, Sciences Po, Paris, France
| | - Alexandra Rendón
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Harold M Pinsky
- DDS Private Practice, Airline Transport Pilot, Lead Line Check Pilot Airbus A-330, Michigan, Ann Arbor, USA
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2
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Halawany HS, Abraham NB, Al-Badr AH, Al-Khalifa KS. Perceptions of Patient Safety Competence Using the Modified Version of the Health Professional Education in Patient Safety Survey (H-PEPSS) Instrument Among Dental Students in Riyadh, Saudi Arabia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1019-1028. [PMID: 36105768 PMCID: PMC9466956 DOI: 10.2147/amep.s369291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
AIM To investigate dental students' self-reported confidence in learning about various domains of patient safety during their clinical training years. METHODS The Health Professional Education in Patient Safety Survey (H-PEPSS) was distributed to the fourth- and fifth-year undergraduate students, interns and postgraduate dental students. The survey explores how the seven domains of the Canadian Patient Safety Institute Safety Competencies Framework and wider cases of patient safety issues are presented in dental education, as well as participants' self-reported comfortability regarding revealing about patient safety issues. A comparison of the patient safety domains scores were assessed through learning scenarios (classroom and clinical), gender, level of study and type of institution. RESULTS Out of 409 participants, 359 undergraduate dental students and 131 postgraduate dental students responded to the survey. Irrespective of the groups, all dental students were most confident regarding their learning aspects about skills pertaining to clinical safety and effective communication and least confident in learning related to managing safety risks. All the patient safety factors irrespective of the scenario, scored above 75% and thus interpreted as good competence. Statistically significant differences were reported among the genders in the classroom scenario for learning about communicating effectively with the patients regarding patient safety issues (p < 0.05). Male dental students, undergraduates and those in the private institution were significantly less confident about recognizing and reporting to immediate risks in the clinical scenario compared to their respective counterparts (p < 0.05). CONCLUSION Based on the results, the dental students are quite confident with regard to the learning aspects of clinical patient safety, nevertheless, their confidence in learning certain patient safety aspects warrants further improvement. This implies a need to address the impact of regular interventions, extra motivation and repeated mentoring in both the classroom and clinical scenarios on improving dental students' confidence about patient safety.
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Affiliation(s)
- Hassan Suliman Halawany
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nimmi Biju Abraham
- School of Oral Health, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Abid Hamoud Al-Badr
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Khalifa S Al-Khalifa
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Hunter J, Porter M, Cody P, Williams B. Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls? Int Emerg Nurs 2022; 63:101174. [PMID: 35594762 DOI: 10.1016/j.ienj.2022.101174] [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: 11/18/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paramedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes. OBJECTIVE The aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley's model for SA, can improve overall SA during emergency calls. METHODS A prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores. RESULTS The overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011. CONCLUSIONS A targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.
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Affiliation(s)
- Justin Hunter
- Department of Paramedicine, Monash University, Australia; Oklahoma State University - Oklahoma City, Paramedicine Program, USA; Norman Regional Hospital - EMSStat, USA; EMS Success, Inc, USA.
| | - Michael Porter
- Department of Paramedicine, Monash University, Australia; Norman Regional Hospital - EMSStat, USA; Oklahoma State University Center for Health Sciences, Emergency Medicine Residency Program, USA; EMS Success, Inc, USA
| | - Patrick Cody
- Oklahoma State University - Oklahoma City, Paramedicine Program, USA; Norman Regional Hospital - EMSStat, USA; Oklahoma State University Center for Health Sciences, Emergency Medicine Residency Program, USA.
| | - Brett Williams
- Department of Paramedicine, Monash University, Australia.
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Ensaldo-Carrasco E, Sheikh A, Cresswell K, Bedi R, Carson-Stevens A, Sheikh A. Patient Safety Incidents in Primary Care Dentistry in England and Wales: A Mixed-Methods Study. J Patient Saf 2021; 17:e1383-e1393. [PMID: 34852417 DOI: 10.1097/pts.0000000000000530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In recent decades, there has been considerable international attention aimed at improving the safety of hospital care, and more recently, this attention has broadened to include primary medical care. In contrast, the safety profile of primary care dentistry remains poorly characterized. OBJECTIVES We aimed to describe the types of primary care dental patient safety incidents reported within a national incident reporting database and understand their contributory factors and consequences. METHODS We undertook a cross-sectional mixed-methods study, which involved analysis of a weighted randomized sample of the most severe incident reports from primary care dentistry submitted to England and Wales' National Reporting and Learning System. Drawing on a conceptual literature-derived model of patient safety threats that we previously developed, we developed coding frameworks to describe and conduct thematic analysis of free text incident reports and determine the relationship between incident types, contributory factors, and outcomes. RESULTS Of 2000 reports sampled, 1456 were eligible for analysis. Sixty types of incidents were identified and organized across preoperative (40.3%, n = 587), intraoperative (56.1%, n = 817), and postoperative (3.6%, n = 52) stages. The main sources of unsafe care were delays in treatment (344/1456, 23.6%), procedural errors (excluding wrong-tooth extraction) (227/1456; 15.6%), medication-related adverse incidents (161/1456, 11.1%), equipment failure (90/1456, 6.2%) and x-ray related errors (87/1456, 6.0%). Of all incidents that resulted in a harmful outcome (n = 77, 5.3%), more than half were due to wrong tooth extractions (37/77, 48.1%) mainly resulting from distraction of the dentist. As a result of this type of incident, 34 of the 37 patients (91.9%) examined required further unnecessary procedures. CONCLUSIONS Flaws in administrative processes need improvement because they are the main cause for patients experiencing delays in receiving treatment. Checklists and standardization of clinical procedures have the potential to reduce procedural errors and avoid overuse of services. Wrong-tooth extractions should be addressed through focused research initiatives and encouraging policy development to mandate learning from serious dental errors like never events.
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Affiliation(s)
- Eduardo Ensaldo-Carrasco
- From the Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Asiyah Sheikh
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Kathrin Cresswell
- From the Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Raman Bedi
- King's College London Dental Institute at Guy's, King's College and St Thomas's Hospitals, Division of Population and Patient Health, King's College London, United Kingdom
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González-Silva NY, Ronceros-Dueñas KA, Tinedo-López PL, Huamaní-Echaccaya JL, Guerrero ME, Malpartida Carrillo V. [Prevention of complications and risk reduction in oral implantology considering human factors and situation awareness]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e048. [PMID: 38464405 PMCID: PMC10919832 DOI: 10.21142/2523-2754-0901-2021-048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/08/2021] [Indexed: 03/12/2024] Open
Abstract
In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures.
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Affiliation(s)
- Nadia Yudy González-Silva
- Estudiante de pregrado, Escuela de Estomatología de la Universidad Privada San Juan Bautista. Lima, Perú. , Universidad Privada San Juan Bautista Estudiante de pregrado, Escuela de Estomatología Universidad Privada San Juan Bautista Lima Peru
| | - Kevin Adonis Ronceros-Dueñas
- Estudiante de pregrado, Escuela de Estomatología de la Universidad Privada San Juan Bautista. Lima, Perú. , Universidad Privada San Juan Bautista Estudiante de pregrado, Escuela de Estomatología Universidad Privada San Juan Bautista Lima Peru
| | - Pedro Luis Tinedo-López
- División de Periodoncia, Escuela de Estomatología de la Universidad Privada San Juan Bautista. Lima, Perú. , Universidad Privada San Juan Bautista División de Periodoncia, Escuela de Estomatología Universidad Privada San Juan Bautista Lima Peru
| | - José Luis Huamaní-Echaccaya
- División de Estomatología, Escuela de Estomatología de la Universidad Privada San Juan Bautista. Ica, Perú. Universidad Privada San Juan Bautista División de Estomatología Escuela de Estomatología Universidad Privada San Juan Bautista Ica Peru
| | - María Eugenia Guerrero
- Departamento Académico Médico Quirúrgico, Facultad de Odontología de la Universidad Nacional Mayor de San Marcos. Lima, Perú. Universidad Nacional Mayor de San Marcos Departamento Académico Médico Quirúrgico Facultad de Odontología Universidad Nacional Mayor de San Marcos Lima Peru
| | - Violeta Malpartida Carrillo
- División de Periodoncia, Escuela de Estomatología de la Universidad Privada San Juan Bautista. Lima, Perú. , Universidad Privada San Juan Bautista División de Periodoncia, Escuela de Estomatología Universidad Privada San Juan Bautista Lima Peru
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Al-Muharraqi MA. Re: What can we do to improve individual and team situational awareness to benefit patient safety? Br J Oral Maxillofac Surg 2020; 58:873-874. [PMID: 32576465 DOI: 10.1016/j.bjoms.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mohammed A Al-Muharraqi
- Royal Medical Services of the Bahrain Defence Force (RMS-BDF), Kingdom of Bahrain; House 292 (Oasis 107), Road 4303, Al Mazrowiah Block 0943, Kingdom of Bahrain.
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Almufleh B, Ducret M, Malixi J, Myers J, Nader SA, Franco Echevarria M, Adamczyk J, Chisholm A, Pollock N, Emami E, Tamimi F. Development of a Checklist to Prevent Reconstructive Errors Made By Undergraduate Dental Students. J Prosthodont 2020; 29:573-578. [PMID: 32282105 DOI: 10.1111/jopr.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To design a checklist in order to reduce the frequency of reconstructive preventable errors (PE) performed by undergraduate dental students at McGill University. MATERIALS AND METHODS The most common PE occurring at a university dental clinic were identified by three reviewers analyzing the refunded cases, and used to create a preliminary checklist. This checklist was then validated by a panel of dental educators to produce a finalized 20-item checklist. The 20-question checklist was then submitted to students in a cross-sectional survey-based study to evaluate its relevance to undergraduate clinical education needs. RESULTS As many as 81% of students reported to have forgotten at least one item of the checklist during care of their last patient, and the most forgotten checklist items corresponded to the pretreatment stage. The students also reported that 17 of the 20 items in the checklist were relevant to a considerable extent or highly relevant. CONCLUSION Common PE identified in the undergraduate clinic could be used to create a checklist of relevant items designed to reduce errors made by students and practitioners performing prosthodontic and reconstructive treatments. However, further studies are required to evaluate the implementation and efficiency of the checklist.
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Affiliation(s)
- Balqees Almufleh
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,King Saud University, Riyadh, Saudi Arabia
| | - Maxime Ducret
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Faculty of Dentistry, Lyon 1 University, Lyon, France.,Odontology Center, Lyon Civils Hospices, Lyon, France
| | - Jodeci Malixi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Myers
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Samer Abi Nader
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | | | - Jessica Adamczyk
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Alicia Chisholm
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Natalie Pollock
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,College of Dental Medicine, Qatar University, Doha, Qatar
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8
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Pinsky HM, Le JM, Sweier DG, Marti K. Dental students' ability to locate emergency equipment-lessons learned from aviation. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e19-e25. [PMID: 28019067 DOI: 10.1111/eje.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the dental student's ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic. METHODS A total of 138 second-year dental students (traditional group) participated in this study as part of a simulation-based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self-reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually. RESULTS Of the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group. CONCLUSION Whilst our students have lecture-based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second-year dental students supported that proper training may be used to achieve retention of knowledge. Based on our "novel group" results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands-on training.
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Affiliation(s)
- H M Pinsky
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J M Le
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - D G Sweier
- Department of Cariology, Restorative Sciences & Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - K Marti
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Abstract
BACKGROUND Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.
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Jean G. Does the accreditation of private dental practices work? Time to rethink how accreditation can improve patient safety. AUST HEALTH REV 2017; 43:10-14. [PMID: 28988568 DOI: 10.1071/ah17085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/08/2017] [Indexed: 11/23/2022]
Abstract
Accreditation to demonstrate engagement with the National Safety and Quality Health Service Standards (Standards) is compulsory for most hospital and healthcare settings, but to date remains voluntary for private dental practices (PDPs). The regulatory framework governing the dental profession lacks a proactive element to drive improvements in quality and safety of care, and an accreditation scheme can strengthen existing regulation. The current model of accreditation operating in accordance with the Australian Health Service Safety and Quality Accreditation Scheme (Scheme) is based on the Standards, which were written for a hospital model of healthcare service. The majority of PDPs are small office-based businesses with clear leadership structure and employing six staff or fewer. The Scheme is overly bureaucratic given the simplicity of the PDP business model. This article considers whether accreditation has a proven track record of improving quality of service and offers opinions about how a more appropriate safety management program for PDPs may look.
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Affiliation(s)
- Gillian Jean
- International Research Collaborative - Oral Health and Equity (IRC-OHE), The School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. Email
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Berthelsen H, Westerlund H, Hakanen JJ, Kristensen TS. It is not just about occupation, but also about where you work. Community Dent Oral Epidemiol 2017; 45:372-379. [PMID: 28421641 DOI: 10.1111/cdoe.12300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level. METHODS All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses. RESULTS First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects. CONCLUSION In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.
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Affiliation(s)
- Hanne Berthelsen
- Centre for Work Life and Evaluation Studies & the Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Hugo Westerlund
- The Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Jari J Hakanen
- Finnish Institute of Occupational Health, Helsinki, Finland
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12
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Affiliation(s)
- Al Ross
- Lecturer in Behavioural Science, University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK,
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Sauter TC, Hautz WE, Hostettler S, Brodmann-Maeder M, Martinolli L, Lehmann B, Exadaktylos AK, Haider DG. Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department. Scand J Trauma Resusc Emerg Med 2016; 24:97. [PMID: 27485431 PMCID: PMC4970284 DOI: 10.1186/s13049-016-0291-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. Methods All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen’s d was calculated as effect size for all statistically significant tests. Results Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (dz = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Discussion Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. Conclusion An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.
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Affiliation(s)
- Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simone Hostettler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Monika Brodmann-Maeder
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Luca Martinolli
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Beat Lehmann
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Dominik G Haider
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Maramaldi P, Walji MF, White J, Etolue J, Kahn M, Vaderhobli R, Kwatra J, Delattre VF, Hebballi NB, Stewart D, Kent K, Yansane A, Ramoni RB, Kalenderian E. How dental team members describe adverse events. J Am Dent Assoc 2016; 147:803-11. [PMID: 27269376 DOI: 10.1016/j.adaj.2016.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although some patients experience adverse events (AEs) resulting in harm caused by treatments in dentistry, few published reports have detailed how dental providers describe these events. Understanding how dental treatment professionals view AEs is essential to building a safer environment in dental practice. METHODS The authors interviewed dental professionals and domain experts through focus groups and in-depth interviews and asked them to identify the types of AEs that may occur in dental settings. RESULTS The initial interview and focus group findings yielded 1,514 items that included both causes and AEs. In total, 632 causes were coded into 1 of the 8 categories of the Eindhoven classification, and 882 AEs were coded into 12 categories of a newly developed dental AE classification. Interrater reliability was moderate among coders. The list was reanalyzed, and duplicate items were removed leaving a total of 747 unique AEs and 540 causes. The most frequently identified AE types were "aspiration and ingestion" at 14% (n = 142), "wrong-site, wrong-procedure, wrong-patient errors" at 13%, "hard-tissue damage" at 13%, and "soft-tissue damage" at 12%. CONCLUSIONS Dental providers identified a large and diverse list of AEs. These events ranged from "death due to cardiac arrest" to "jaw fatigue from lengthy procedures." PRACTICAL IMPLICATIONS Identifying threats to patient safety is a key element of improving dental patient safety. An inventory of dental AEs underpins efforts to track, prevent, and mitigate these events.
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Merijohn GK. Management and prevention of gingival recession. Periodontol 2000 2016; 71:228-42. [DOI: 10.1111/prd.12115] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 01/10/2023]
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Prakasam S, Stein K, Lee MK, Rampa S, Nalliah R, Allareddy V, Allareddy V. Prevalence and predictors of complications following facial reconstruction procedures. Int J Oral Maxillofac Surg 2016; 45:735-42. [PMID: 26819151 DOI: 10.1016/j.ijom.2015.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/17/2015] [Accepted: 12/24/2015] [Indexed: 11/17/2022]
Abstract
Facial reconstruction procedures are immensely challenging and are done for a multitude of reasons. The purpose of this report is to provide nationally representative estimates of different types of facial reconstructive procedures and to examine prevalence and predictors of a wide range of complications associated with these procedures in the USA. The Nationwide Inpatient Sample, the largest inpatient dataset for the USA, was used. Data for the years 2004-2010 related to facial reconstruction procedures were identified through ICD-9-CM procedure codes. Associated complications were identified using secondary diagnosis field codes. Multivariable logistic regression models were used to examine the association between patient/hospital-level factors and the occurrence of complications. A total 26,374 facial reconstruction procedures were performed. About 20% of all patients who had facial reconstruction procedures developed a complication. Frequently occurring complications included postoperative pneumonia (4.9% of hospitalizations), hemorrhage (3.9%), other infections (3.6%), non-healing wounds (3.5%), and iatrogenically induced complications (3.2%). Significant factors found to be consistently associated with different types of complications included age, co-morbid burden, sex, and type of admission. The reported results are generalizable within limitations and can be used by health care providers to tailor quality improvement initiatives to minimize or better treat complications in the high-risk cohorts.
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Affiliation(s)
- S Prakasam
- Department of Periodontology, Oregon Health and Sciences University, Portland, OR, USA
| | - K Stein
- Department of Oral and Maxillofacial Surgery, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA
| | - M K Lee
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - S Rampa
- University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | - R Nalliah
- College of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - V Allareddy
- Department of Pediatric Critical Care, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - V Allareddy
- Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City, IA, USA.
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Bailey E, Tickle M, Campbell S, O'Malley L. Systematic review of patient safety interventions in dentistry. BMC Oral Health 2015; 15:152. [PMID: 26613736 PMCID: PMC4662809 DOI: 10.1186/s12903-015-0136-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 11/11/2015] [Indexed: 11/11/2022] Open
Abstract
Background The concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve patient safety or to minimise the occurrence of adverse events. Methods The aim of this qualitative systematic review was to search the academic and grey literature to identify and assess tools or interventions used in dental care settings to maintain or improve patient safety. All study designs were included from all dental care settings. Outcome measures were: patient safety, harm prevention, risk minimization, patient satisfaction and patient acceptability, professional acceptability, efficacy, cost-effectiveness and efficiency. Quality assessments were performed on the included studies based on CASP tools. Further analysis was undertaken to discover whether any of the tools had been trialled or verified by the authors, or by subsequent authors. Results Following abstract screening, and initial qualitative synthesis, nine studies were found to meet the inclusion criteria with 31 being excluded following initial analysis. Tools identified included: checklists (4 studies), reporting systems (3), the use of electronic notes (1) and trigger tools (1). Grey literature searching did not identify any further appropriate studies. In terms of study design, there were observational studies including audit cycles (5 studies), epidemiological studies (3) and prospective cluster randomised clinical trials (1). The quality of the studies varied and none of their outcomes were verified by other researchers. The tools identified have the potential to be used for measuring and improving patient safety in dentistry, with two surgical safety checklists demonstrating a reduction in erroneous dental extractions to nil following their introduction. Reporting systems provide epidemiological data, however, it is not known whether they lead to any improvement in patient safety. The one study on trigger tools demonstrates a 50 % positive predictive value for safety incidents. It is not clear as to what impact the introduction of electronic guidelines has on patient safety outcomes. Conclusions This systematic review finds that the only interventions in dentistry that reduce or minimise adverse events are surgical safety checklists. We believe this to be the first systematic review in this field; it demonstrates the need for further research into patient safety in dentistry across several domains: epidemiological, conceptual understanding and patient and practitioner involvement. Electronic supplementary material The online version of this article (doi:10.1186/s12903-015-0136-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edmund Bailey
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK.
| | - Martin Tickle
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK.
| | - Stephen Campbell
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK.
| | - Lucy O'Malley
- School of Dentistry, University of Manchester, J R Moore Building, Oxford Road, Manchester, M13 9PL, UK.
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Hiivala N, Mussalo-Rauhamaa H, Tefke HL, Murtomaa H. An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland. Acta Odontol Scand 2015; 74:81-9. [PMID: 25967591 DOI: 10.3109/00016357.2015.1042040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland. MATERIALS AND METHODS The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases. RESULTS Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications. CONCLUSIONS Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.
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Affiliation(s)
- Nora Hiivala
- a 1 Oral Public Health, Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki , Helsinki, Finland
- b 2 FINDOS Helsinki, Doctoral Programme in Oral Sciences, University of Helsinki , Helsinki, Finland
| | - Helena Mussalo-Rauhamaa
- c 3 Public Health, Hjelt Institute, Faculty of Medicine, University of Helsinki , Helsinki, Finland
- d 4 Regional State Administrative Agency for Southern Finland , Helsinki, Finland
| | - Hanna-Leena Tefke
- e 5 National Supervisory Authority for Welfare and Health , Helsinki, Finland
| | - Heikki Murtomaa
- a 1 Oral Public Health, Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki , Helsinki, Finland
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Obadan EM, Ramoni RB, Kalenderian E. Lessons learned from dental patient safety case reports. J Am Dent Assoc 2015; 146:318-26.e2. [PMID: 25925524 PMCID: PMC4418181 DOI: 10.1016/j.adaj.2015.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/23/2014] [Accepted: 01/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Errors are commonplace in health care, including dentistry. It is imperative for dental professionals to intercept errors before they lead to an adverse event and to mitigate their effects when an adverse event occurs. This requires a systematic approach at both the profession level, encapsulated in the Agency for Healthcare Research and Quality's patient safety initiative framework, as well as at the practice level, in which crew resource management is a tested paradigm. Supporting patient safety at both the profession and dental practice levels relies on understanding the types and causes of errors, which have not been well studied. METHODS The authors performed a retrospective review of dental adverse events reported in the literature. Electronic bibliographic databases were searched, and data were extracted on background characteristics, incident description, case characteristics, clinic setting where adverse event originated, phase of patient care that adverse event was detected, proximal cause, type of patient harm, degree of harm, and recovery actions. RESULTS The authors identified 182 publications (containing 270 cases) through their search. Delayed treatment, unnecessary treatment, or disease progression after misdiagnosis was the largest type of harm reported. Of the reviewed cases, 24.4% of those patients involved in an adverse event experienced permanent harm. One of every 10 case reports reviewed (11.1%) reported that the adverse event resulted in the death of the affected patient. CONCLUSIONS Published case reports provide a window into understanding the nature and extent of dental adverse events; however, the overall dearth of publications on adverse events in the dental literature points to the need for more study. PRACTICAL IMPLICATIONS Siloed and incomplete contributions to dentistry's understanding of adverse events in the dental office are threats to dental patients' safety. Publishing more, and more comprehensive, case reports on adverse events is recommended for dental practitioners.
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Affiliation(s)
- Enihomo M. Obadan
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115
| | - Rachel B. Ramoni
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, and the executive director, Undiagnosed Diseases Coordinator Center, Center for Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Elsbeth Kalenderian
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, and the chief of quality, Harvard Dental Center, Boston, MA
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Holliday R, Venugopal S, Howell A, Keys W. Operator's ability at assessing a high-speed (air turbine) handpiece before use: an audit. Br Dent J 2015; 218:E3. [DOI: 10.1038/sj.bdj.2015.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/09/2022]
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Abstract
PURPOSE In 2003, the Institute of Medicine's (IOM) Committee on Health Professions Education Summit reported that students in all health professions should demonstrate competency in patient safety and performance improvement strategies to reduce the incidence of preventable medical errors. These recommendations have been adopted in medical, pharmacy, and nursing accreditation standards, yet not required in dental education. The purpose of this study was to explore if 4-year oral and maxillofacial surgery (OMFS) residency programs are aligned with other health professions in following the Institute of Medicine's recommendations to incorporate evidence-based patient safety training in the postgraduate curricula. METHODS In October of 2012, a multiple choice questionnaire was sent to 27 four-year oral and maxillofacial surgery residency program directors via a link to Survey Monkey. A descriptive analysis of responses was performed upon achieving a 74% response rate. RESULTS Ninety-five percent of the responding 4-year OMFS programs have integrated patient safety training in the residency curriculum. Seventy percent complete between 2 and 10 hours of safety training per academic year. Eighty percent of the programs apply human factors and system engineering theories in morbidity and mortality conferences, and 50% require residents to perform root cause analyses (RCA) of adverse events. CONCLUSIONS The results of this study indicate that the majority of 4-year OMFS programs include patient safety education in the residency curriculum, although the duration of training and integration of acquired knowledge into practice varied among participants.
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The Culture of Safety. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hiivala N, Mussalo-Rauhamaa H, Murtomaa H. Patient safety incident prevention and management among Finnish dentists. Acta Odontol Scand 2013; 71:1663-70. [PMID: 24087859 DOI: 10.3109/00016357.2013.797103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Assessing current patient safety incident (PSI) prevention measures and risk management practices among Finnish dentists. MATERIALS AND METHODS A total of 1041 dentists practicing in the private or public sectors in southern Finland completed an online questionnaire concerning PSI prevention, PSI-reporting systems, feedback and knowledge gained from device incidents and patient-generated safety information and the knowledge of national PS-guidance. The answers were handled anonymously. Statistical evaluations were performed using chi-square analysis. RESULTS Dentists suggested multiple methods for preventing PSIs related to dental diagnostics, various treatments, equipment and devices, medications, communication, infection control and general practice safety. Preventive methods reported most frequently included working with caution and forethought, keeping accurate patient records and the availability of correct patient information. A special PSI-reporting system was used by less than one third of respondents. Feedback received on PS-related data and the utilization of guidebooks varied significantly between the studied dentist groups. CONCLUSIONS Several PSI prevention techniques are already used in Finland. However, wide variation exists in PSI prevention and risk management practices among Finnish dentists. Systematic implementation of available safety methods would probably prevent several PSIs. The results indicate that the more dentists know about PS risks, the easier it is for them to recognize situations possibly leading to patient harm. Anonymous PSI reports, patient complaints and claims data should, therefore, be actively used for mutual learning. Increased PS education in dentistry is also needed.
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Affiliation(s)
- Nora Hiivala
- Department of Oral Public Health, Institute of Dentistry, University of Helsinki , Helsinki , Finland
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Taichman RS, Parkinson JW, Nelson BA, Nordquist B, Ferguson‐Young DC, Thompson JF. Program Design Considerations for Leadership Training for Dental and Dental Hygiene Students. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.2.tb05246.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Russell S. Taichman
- Department of Periodontics and Oral Medicine Scholars Program in Dental Leadership, University of Michigan School of Dentistry
| | - Joseph W. Parkinson
- Department of Restorative DentistryUniversity of Missouri‐Kansas City School of Dentistry
| | - Bonnie A. Nelson
- Loma Linda University School of DentistryDepartment of Hospital DentistryLoma Linda University Medical Center
| | | | - Daphne C. Ferguson‐Young
- Department of Restorative Dentistry, and Director, GPR Program Meharry Medical College School of Dentistry
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Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas 2011; 24:7-13. [PMID: 22313554 DOI: 10.1111/j.1742-6723.2011.01495.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Effective team management is a core element of expert practice in emergency medicine. Thus far, training in emergency medicine has focussed predominantly on proficiency in medical and technical skills, with emergency physicians acquiring these 'non-technical' skills in an ad hoc manner or by trial and error with varying levels of success. This paper describes a set of behaviours that, when practised in conjunction with medical and technical expertise, can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of an ED. Teaching and practice of these behaviours is now a core element of training and skills maintenance in other high-risk areas, such as aviation, and is becoming part of the routine training for anaesthetists. They address areas, such as communication, leadership, knowledge of environment, anticipation and planning, obtaining timely assistance, attention allocation and workload distribution. We outline the application of these behaviours in the speciality of emergency medicine, and suggest that the teaching and practice of crisis resource management principles should become part of the curriculum for training and credentialing of emergency medicine specialists.
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Affiliation(s)
- Belinda Carne
- Emergency Department, Geelong Hospital, Geelong, Victoria, Australia.
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