Office of Clinical Affairs, Harvard School of Dental Medicine, Boston, Mass. 02115, USA.
J Am Dent Assoc. 2013 Jul;144(7):808-14. doi: 10.14219/jada.archive.2013.0191.
There is a dearth of knowledge about the type and frequency of adverse events (AEs) in dentistry. Current approaches to obtaining information rely on reviews of randomly selected records, which may not be the most efficient or effective methodology.
Inspired by the Institute for Healthcare Improvement's (IHI) global and outpatient trigger tools, which identifies records with characteristics ("triggers") that are associated with AEs, the authors created the dental clinic trigger tool. The triggers included procedures for incision and drainage, failed implants and selected treatment patterns. The authors ran the trigger tool against six months of electronic health records data and compared its performance with that of a review of 50 randomly selected patient records.
In total, 315 records were triggered, 158 (50 percent) of which were positive for one or more AEs; 17 (34 percent) of the 50 randomly selected records were positive for at least one AE. The authors assigned each AE an IHI severity ranking. Most AEs caused temporary harm, but nine were considered to have caused permanent harm according to a modified IHI severity ranking.
The study results demonstrate the promise of a directed records review approach, as the dental clinic trigger tool was more effective in identifying AEs than was a review of randomly selected records.
All dental practices should proactively monitor the safety of the care they provide. Use of the trigger tool will help make this process more efficient and effective.
目前，人们对牙科领域不良事件（AE）的类型和频率知之甚少。当前获取相关信息的方法依赖于对随机选择记录的审查，但这种方法可能不是最有效或最有效的。
受国际医疗保健改进研究所（IHI）全球和门诊触发工具的启发，该工具可识别与 AE 相关的具有特征（“触发因素”）的记录，作者创建了牙科诊所触发工具。这些触发因素包括切开引流术、种植体失败和选定的治疗模式等相关操作。作者将触发工具应用于六个月的电子健康记录数据，并将其性能与对 50 份随机选择的患者记录的审查进行比较。
共触发了 315 份记录，其中 158 份（50%）记录存在一个或多个 AE；在随机选择的 50 份记录中，有 17 份（34%）至少存在一个 AE。作者对每个 AE 进行了 IHI 严重程度分级。大多数 AE 造成的是暂时伤害，但根据改良的 IHI 严重程度分级，有 9 个 AE 被认为造成了永久性伤害。
研究结果表明，定向记录审查方法具有一定的应用前景，因为牙科诊所触发工具在识别 AE 方面比随机选择记录的审查更有效。
所有牙科诊所都应主动监测其提供的护理的安全性。使用触发工具将有助于提高这一过程的效率和效果。
