Quality Improvement and Reporting Systems: What the Oral and Maxillofacial Surgeon Should Know

Surgical safety checklists for dental implant surgeries-a scoping review

OBJECTIVES

In both elective surgeries and aviation, a reduction of complications can be expected by paying attention to the so-called human factors. Checklists are a well-known way to overcome some of these problems. We aimed to evaluate the current evidence regarding the use of checklists in implant dentistry.

METHODS

An electronic literature search was conducted in the following databases: CINHAL, Medline, Web of Science, and Cochrane Library until March 2022. Based on the results and additional literature, a preliminary checklist for surgical implant therapy was designed.

RESULTS

Three publications dealing with dental implants and checklists were identified. One dealt with the use of a checklist in implant dentistry and was described as a quality assessment study. The remaining two studies offered suggestions for checklists based on literature research and expert opinion.

CONCLUSIONS

Based on our results, the evidence for the use of checklists in dental implantology is extremely low. Considering the great potential, it can be stated that there is a need to catch up. While creating a new implant checklist, we took care of meeting the criteria for high-quality checklists. Future controlled studies will help to place it on a broad foundation.

CLINICAL RELEVANCE

Checklists are a well-known way to prevent complications. They are especially established in aviation, but many surgical specialties and anesthesia adopt this successful concept. As implantology has become one of the fastest-growing areas of dentistry, it is imperative that checklists become an integral part of it.

Dentists' practices and patient safety: A cross-sectional study

PURPOSE

To assess the frequency of dentist-reported practices to ensure patient safety in the dental office and the impact of training and work environment on this frequency using the framework of the International Patient Safety Goals (IPSGs).

METHODS

Dentists attending major conferences in Egypt and Saudi Arabia were recruited in a cross-sectional study in 2018. They completed a questionnaire assessing professional background and the frequency of practices for the IPSGs. The relationship between explanatory variables: training (postgraduate degrees and continuing education) and work environment (years in profession, working in public sector and performing surgical procedures) and the outcome variable: frequency of practices for 4 IPSGs was assessed using multivariate general linear model, and univariate general linear model was used to assess their relationship to the overall score of safety practices calculated for all goals.

RESULTS

The response rate was 81.1%. Practices related to reducing harm in the office environment were significantly less frequent than practices ensuring medication safety, ensuring safe surgery and controlling infection. The overall frequency of safety practices was significantly higher amongst senior than junior dentists. There were significant differences in safety practices frequency based on postgraduate degrees and receiving safety training. Dentists performing surgical procedures reported less frequent safety practices.

CONCLUSION

Practices to reduce harm because of the dental office environment were less frequent than other safety practices. Senior dentists, dentists who had postgraduate degrees and who received safety training reported more safety practices whilst those performing surgical procedures reported fewer safety practices.

Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China

OBJECTIVES

To develop a risk-stratified intervention strategy and evaluate its effect on reducing surgical complications.

DESIGN

A multicentre prospective study with preintervention and postintervention stages: period I (January to June 2015) to develop the intervention strategy and period II (January to June 2016) to evaluate its effectiveness.

SETTING

Four academic/teaching hospitals representing major Chinese administrative and economic regions.

PARTICIPANTS

All surgical (elective and emergent) inpatients aged ≥14 years with a minimum hospital stay of 24 hours, who underwent a surgical procedure requiring an anesthesiologist.

INTERVENTIONS

Targeted complications were grouped into three categories (common, specific, serious) according to their incidence pattern, severity and preventability. The corresponding expert consensus-generated interventions, which focused on both regulating medical practices and managing inherent patient-related risks, were implemented in a patient-tailored way via an electronic checklist system.

PRIMARY AND SECONDARY OUTCOMES

Primary outcomes were (1) in-hospital death/confirmed death within 30 days after discharge and (2) complications during hospitalisation. Secondary outcome was length of stay (LOS).

RESULTS

We included 51 030 patients in this analysis (eligibility rate 87.7%): 23 413 during period I, 27 617 during period II. Patients' characteristics were comparable during the two periods. After adjustment, the mean number of overall complications per 100 patients decreased from 8.84 to 7.56 (relative change 14.5%; P<0.0001). Specifically, complication rates decreased from 3.96 to 3.65 (7.8%) for common complications (P=0.0677), from 0.50 to 0.36 (28.0%) for specific complications (P=0.0153) and from 3.64 to 2.88 (20.9%) for serious complications (P<0.0001). From period I to period II, there was a decreasing trend for mortality (from 0.64 to 0.53; P=0.1031) and median LOS (by 1 day; P=0.8293), without statistical significance.

CONCLUSIONS

Implementing a risk-stratified intervention strategy may be a target-sensitive, convenient means to improve surgical outcomes.