Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Until recently research on patient safety (PS) focused on secondary care, and little was known about the risks that patients face in primary care and especially in dental care. Only few studies have hitherto focused on the understanding of either the patients or their families about safety in dentistry. The objectives of this thesis were to identify types of dental patient safety incidents (PSIs), the contributory factors that played a role on the origin, development of PSIs, or identify the factors that increased the risk of PSIs, the mitigating factors against PSI, suggested by dentists and PS practices in use in their clinics. Furthermore, this thesis aimed at exploring whether patients or their families are able to observe PSIs in their own dental care. The study findings were derived from two datasets: 1) The first dataset was obtained from an internet-based questionnaire, sent in 2010 that requested practicing dentists to respond to questions on any PSIs that had occurred during the preceding year and any incident mitigating factors. A total of 1041 dentists responded (response rate 54%) and almost one third reported PSI(s) (n=872). 2) The second dataset was compiled from national data on patients or their family complaints and other notifications made against individual dental practitioners or dental practice units (n=948) for six Regional State Administrative Agencies (AVIs) and also from the National Supervisory Authority for Welfare and Health (Valvira) in Finland from 2000 to 2012 inclusive. The study used quantitative and qualitative research methods. Qualitative analyses (root cause analysis and document analysis) aimed to find emergent themes of dental PSIs and the factors related to them. The quantitative analyses examined several variables related to incident types, which included the contributing factors, the mitigating factors and their associations with dentists characteristics. The detected dental incident types in Finland are in many ways identical to reports from other countries. The two datasets provided somewhat different pictures of PSIs in dentistry. The dentists incident reports mostly captured incidents with relatively low severity, whereas patient complaints and supervisory data of healthcare regulators captured rarer but more serious events. This study showed that PS in dentistry is a complex and multidimensional issue and it relates to all aspects of care; diagnostics, treatment, devices and premises, medications, leadership and management, infection control, teamwork, communication, practitioner characteristics and patient characteristics. All dental PSIs in both datasets had a broad array of contributing factors including both human factors and latent system-factors. Compared to the total number of annual dental visits in Finland, severe dental PSIs are rare. However, less severe PSIs are more common, especially in prosthetics, dental surgery, endodontic and restorative treatments. According to dentist reports no significant difference existed in the incident rate between public and private dental practice. Yet two thirds (68%) of all studied patient complaints and other notifications concerned private professionals, whereas one third concerned public dental providers (32%). Most patients or family lodged complaints were lodged against individual dental professionals and only a minority was issued against dental practices or organizations. Nine out of ten complaints were made against dentists, the majority being general dental practitioners. Most (83%) dental professionals were complained about only once during the study period, however, a small number of dentists were responsible for a notable proportion of complaints from patients or received notifications concerning dentistry. These complaint-prone dentists carried a significantly higher risk for PSIs than did other dentists. The study also showed that patients and their families can be observant and are capable of identifying several incidents and hazardous circumstances in their dental care. Even serious safety risks that were otherwise probably not captured can be detected. The results show a relatively high prevalence of preventable incidents in Finnish dentistry. On the other hand, several mitigating factors had already implemented every day dental practice to safeguard patients in Finland. The problem is that the active use of novel methods varies between individuals and organizations. Patient protection in dentistry can be further enhanced by creating a more open PS culture. Such a culture should include improved incident reporting and should focus on learning from adverse events and also near misses. Anonymous, easy-to-use and blame-free reporting systems tailored for the specific features of dentistry might facilitate reporting. Development of proactive ways to intervene against complaint-prone dentists early and effectively to prevent an escalation of problems is also needed. PS issues should be implemented in undergraduate, post-graduate and continuing professional training. Further research should use different datasets, target groups (health care professionals, patients and their families), several PS research methods and include physical, emotional, social and economic consequences of dental incidents. Keywords: Patient safety, dentistry, incident type, degree of harm, prevention, patient complaints, malpractice
Source: Työväentutkimus Vuosikirja
Author: Nora Hiivala
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Helsingin Yliopisto
OpenAlex ID: W2268554831