Ensuring

Patient Safety

in Dentistry

Denice Stewart, DDS, MHSA Senior Associate Dean, Clinical Affairs

Oregon Health & Science University School of Dentistry

Elsbeth Kalenderian, DDS, MPH Chair, Department of Oral Health Policy and Epidemiology

Harvard School of Dental Medicine

Objectives

• Provide an overview of the current state of patient safety in dentistry

• Discuss the importance of establishing a culture of patient safety as foundational for success

• Propose next steps in establishing a patient safety system in dentistry

Patient Safety in Dentistry CURRENT STATE

Health Care is Hazardous

Some Demonstrated EHR Benefits • Improve quality and convenience of patient

care (DesRoches 2008)

• Improve efficiency & productivity and increase patient participation in their care (www.healthit.gov)

• Improve accuracy of diagnoses and outcomes (Ciemins 2009; Baron 2007; Duffy 2010; Hunt 2009; Bell 2010; Fiks 2007; Holt 2010)

• Full implementation of IT could save $77.8 billion annually. (Center for IT Leadership)

• Improve care coordination, clinical decision making and communication (Chaudry, 2006)

Who Judges Quality in Medicine?

• Regional Consortia & Collaboratives • State Health Departments • Clinical Bodies (ie. AHA, AMA, etc.) • Media (Fortune, US News & World Report,

etc. • Health Care Organizations

▫ Dashboard, Scorecards, Satisfaction, etc….

• CMS • JCAHO • Solucient • HealthGrades

• IHI 100k • Leapfrog/NQF • Payors • Health Systems

Clinician

Consumer

David Blum, White Plains Hospital Center

Who Judges Quality in Dentistry ?

• Payors • State Health Departments • Clinical Bodies (ADA, etc.) • Media (Fortune, US News & World Report,

etc.

Clinician

Consumer

David Blum, White Plains Hospital Center

Safety: freedom from accidental injury

Patient safety vocabulary

Adverse event: an injury resulting from a medical intervention (i.e., not due to the underlying clinical condition of the patient)

Preventable adverse event: an adverse event that was attributable to a clinical error.

Error: the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim; not all errors result in injury. Errors can include problems in practice, products, procedures, and systems.

Institute of Medicine

Patient Safety in Dentistry

A CULTURE OF SAFETY

Why is culture

important?

Access and Improve Quality and

Patient Safety Culture

Plan

Effective Governance

Relation-ships

Informa-tion

Measure-ment

Know-ledge

Skills and Roles

http://www.patientsafetyinstitute.ca

Can we

measure

culture?

Medical Office Survey on Patient Safety Culture. January 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture /medical-office/ resources/index.html

• Medical Office Survey On Patient Safety Culture

• Survey focused on patient safety culture in outpatient clinics

Survey concepts

Patient safety and quality issues

Information exchange and communication

Teamwork

Work pressure

and pace

Staff training

Office processes and standardization

Communication openness

Patient care tracking

/follow up

Communication

about error

Leadership support

for safety

Organizational

Learning

Overall perceptions of patient

safety and quality

Survey of health care entities

team members

• Administered at 3 dental schools and a large group, multi-office dental practice

• Data from literature for medical*

*more current medical data is now available but not reflected

in this presentation

Comparison- % response

Overall Quality Items Dental Schools

Dental Group

Practice

Medical Institutions

Patient-centered: Office is responsive to individual patient preferences, needs + values

Excellent 13 27 29

Very good 38 31 39

Good 35 28 26

Fair 10 11 5

Poor 4 3 1

Effective: Care is based on scientific knowledge

Excellent 17 35 27

Very good 44 34 42

Good 31 26 26

Fair 6 4 4

Poor 1 <1 0

Comparison- % response Overall Quality Items

Dental Schools

Dental Group

Practice

Medical Institutions

Timely: Minimizes waits and potentially harmful delays

Excellent 6 16 17

Very good 26 30 33

Good 32 31 31

Fair 20 20 14

Poor 15 4 4

Efficient: Ensure cost-effective care (avoids waste, overuse, and misuse of services)

Excellent 13 22 20

Very good 20 34 37

Good 33 36 32

Fair 22 8 9

Poor 11 1 2

Comparison- % response

Overall Quality Items Dental

Schools

Dental Group

Practice

Medical Institutions

Equitable: Provides same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc.

Excellent 41 53 51

Very good 25 28 30

Good 27 16 15

Fair 6 2 3

Poor 1 <1 1

Overall rating on Quality and Patient Safety

Excellent 11 27 22

Very good 37 39 43

Good 37 25 27

Fair 12 9 7

Poor 3 <1 1

Discussion: should we compare???

Dental School

Medical

Institution Dental Practice

Discussion: focus on collaboration

Dental School

Medical

Institution

Dental Practice

Patient Safety in Dentistry

CREATING A PATIENT SAFETY SYSTEM

Even in the dental office.

Developing a Patient Safety System

for Dentistry

R01, 5-Year NIH/NIDCR Grant

Dental Schools of University of Texas Houston, Harvard University, University of California San Francisco, Oregon Health & Science University

1. Develop the tools to document dental AEs

2. Generate a classification scheme and repository to organize AEs

3. Enable five dental organizations to systematically collect and analyze AEs

Aim 1: Develop a useable and

validated Patient Safety Toolkit (PST)

for documenting AEs in the dental

setting

Pa t i e n t Sa f e t y W o rkg ro u p

D o ma i n Exp e rt s

Ad ve rse Eve n t

I n ve n t o ry 2 . 0

Ad ve rse Eve n t

I n ve n t o ry 3 . 0

Ad vi so ry C o mmi t t e e

Pa t i e n t Sa f e t y W o rkg ro u p

Pa t i e n t Sa f e t y

T o o l ki t 1 . 0

Ad vi so ry C o mmi t t e e

Va l i d a t e Pa t i e n t Sa f e t y

T o o l ki t 3 . 0

Pa t i e n t Sa f e t y W o rkg ro u p U sa b i l i t y

Pa t i e n t Sa f e t y

T o o l ki t 2 . 0

Aim 2: Develop a data repository to

systematically organize dental AEs into

a common framework structured

according to the Dental Patient Safety

Classification

CauseDomainTypeImpact

MEDICAL• Psychological

• Physical Minimal harm Death

NON MEDICAL• Legal

• Social

• Economic

COMMUNICATION• Inaccurate and

incomplete information

PATIENT MANAGEMENT• Questionable tracking

or follow-up

CLINICAL PERFORMANCE• Pre-intervention• Intervention

STAFF• Dentist

SETTING• Ambulatory care clinic

PATIENT• Age• Diagnosis

TARGET• Therapeutic• Cosmetic

SYSTEMS• Organizational

• Technical

HUMANS• Patient

• Practitioner

• External

Aim 3: Disseminate the PST and

determine occurrence characteristics

of dental AEs at 5 institutions

Deploy PST a t 5 Si t e s

Po p u l a te D a t a R e p o si t o ry

A n a l y ze AE R a t e

AE C a u se s

Ev a l u a te U se f u l n e ss U sa b i l i t y

Rfine Pa t i e n t Sa f e t y T o o l ki t

D a t a R e p o si t o ry C l a ssi fica t i o n Syst e m

Acknowledgments

Supported in part by NIDCR: R01DE022628

Rachel Ramoni, DMD, ScD (Harvard Medical School)

Muhammad Walji, PhD (UT Houston)