Systematic review of patient safety interventions in dentistry

Abstract

BackgroundThe 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.MethodsThe 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.ResultsFollowing 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.ConclusionsThis 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 materialThe online version of this article (doi:10.1186/s12903-015-0136-1) contains supplementary material, which is available to authorized users.

A national survey of the public's views on quality in dental care

“…These developments will lead to the production of a definition and a systematic means of measuring quality. The systematic reviews 6,7 demonstrate that such a model cannot be build up from the sparse literature, and qualitative and quantitative primary research is required to develop our knowledge and understanding. Developing and validating a definition and measuring instrument would be a significant step forward.…”

Never events: Patient safety definitions

“…7 Patient safety in dentistry is an emerging field with a paucity of empirical evidence about the frequency and burden of patient safety incidents in dentistry, and limited understanding of why errors occur. 8 This lack of data hinders progress to develop effective interventions to reduce unintended harm in dental settings. Agenda setting studies of the kind that we have undertaken are paramount for laying firm foundations from which the field can grow.…”

Attitudes of dental undergraduate students towards patient safety in a UK dental school

“…One attempt to reduce the reported increase in "never events" within dentistry is the use of a surgical safety checklist; these have been shown to be a valid tool for improving patient safety. 10 The modified WHO surgical safety checklist is currently used in operating theatres throughout the United Kingdom and the world. In the early 2000s, it was noted that at least half of all surgical complications were avoidable.…”