How dental team members describe adverse events

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.

Keywords: Adverse event; cause; classification; dentistry; never event.

Figure 1

Eight Phases of Analysis for domain expert and focus group findings

Figure 2

Frequency of responses by domain experts and focus groups participants that were classified as Causes and AEs.

Figure 3

Based on: TW van der Schaaf, Eindhoven Classification Model for Medical Domain

Figure 4

Items coded by the Dental AE Classification* (N=747) *Note that we do not consider Quality of Care (QoC) issues adverse events; those events were included in the analysis as they made up 10% of the overall reported events. WSPEs: Wrong site, wrong patient errors.