Classifying Adverse Events in the Dental Office

Abstract

Background: Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as "unnecessary harm due to dental treatment." In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office.

Methods: Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications.

Results: A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient.

Conclusions: Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

Figure 1

Dental AE Severity Tree Description of Dental AE Severity Categories:

1. Category E1: Temporary (reversible or transient) minimal/mild harm to the patient

2. Category E2: Temporary (reversible or transient) moderate to severe harm to the patient

3. Category F: Harm to the patient that required transfer to emergency room and/or prolonged hospitalization

4. Category G1: Permanent minimal/mild patient harm

5. Category G2: Permanent moderate to severe patient harm

6. Category H: Intervention required to sustain life

7. Category I: Patient death

Severity tree showing the chart review process for assigning severity categories to an adverse event. The reviewer begins on the left side and follows the branches of the tree to the right by answering each question.

Figure 2

Patient safety is a core component of quality of care. (Institute of Medicine (2000) To Err Is Human) A hypothetical illustration of safety as a component of quality dental care delivery using tooth crowns. The smallest circle represents the attempt to keep the patient free from accidental injury by ensuring the patient does not aspirate the crown. This fits into the bigger circle of quality by ensuring the crown is functional. The last piece of quality is to ensure that it meets the patient’s preference and aesthetic expectations.