RESUMEN
Dental schools establish quality assurance (QA) programs that are intended to improve patient care, comply with requirements of liability carriers and regulatory agencies, and maintain accreditation. Data collection, trend analysis, and interventions are typically used in QA programs to monitor and improve compliance. The purpose of this article is to discuss unfavorable trends and examine the effect of targeted interventions in three clinical operations: infection control, removable prosthodontics, and case reviews of students' patient care in progress (interim case reviews) at a U.S. dental school. Infection control compliance was evaluated and interventions were implemented beginning in 2002 to correct unfavorable trends in two protocols: placement of students' mobile supply cart and the use of overgloves. A predelivery esthetic consent was introduced in spring 2004 to decrease esthetic failures in removable prosthodontics. For interim case reviews, two areas received interventions going back to 2003: reevaluation following initial periodontal therapy and orthodontic screening. The data presented are not meant to show conclusive success of particular interventions, but to display broad trends and suggest methods to manage quality assurance parameters. These trends suggest we had better success with the interventions that were simple, valuable, measurable, and repeatable than with interventions that less fit these criteria.
Asunto(s)
Clínicas Odontológicas/normas , Clínicas Odontológicas/tendencias , Garantía de la Calidad de Atención de Salud , Registros Odontológicos/normas , Fracaso de la Restauración Dental , Dentadura Parcial Removible/normas , Estética Dental , Adhesión a Directriz , Humanos , Control de Infección Dental/normas , Atención al Paciente/normas , Facultades de OdontologíaRESUMEN
Reports of clinical injuries made to a dental school Office of Occupational Health and Safety at the time of their occurrence were compared to self-reports on a survey for dental students in five classes at various times over their educational careers. The majority of injuries were from needlesticks and mishaps with hand instruments. Underreporting at the time of injury was approximately one-third in the first clinical year and one-half in the final clinical year of the three-year program. Students reported a greater perceived likelihood of injury later in their education than at the beginning but a decreased fear of such injuries. Female students reported more needlesticks and a greater fear of injury than did male students. It is hypothesized that a personal interpretation of the meaning of clinical injuries influences reporting behavior.
Asunto(s)
Accidentes de Trabajo , Actitud Frente a la Salud , Exposición Profesional , Estudiantes de Odontología/psicología , Accidentes de Trabajo/estadística & datos numéricos , Instrumentos Dentales/efectos adversos , Miedo/psicología , Femenino , Humanos , Masculino , Lesiones por Pinchazo de Aguja/epidemiología , Exposición Profesional/estadística & datos numéricos , Factores de Riesgo , San Francisco/epidemiología , Facultades de Odontología , Estudiantes de Odontología/estadística & datos numéricosRESUMEN
Quality assurance (QA) programs in dental schools have a component of their program devoted to treatment outcomes. To this end, our institution has implemented TOUCH (Treatment Outcomes Unacceptable for Clinical Health) seminars and Unusual Occurrence Reports (UORs). The seminars allow a faculty member to present a case to faculty and students with feedback from the audience on how the case was managed. The UORs track clinical incidents outside the range of normal. Participation in both of these QA measures has been less than expected. The goal of the current study was to discover the reasons for participation and lack of participation. A twelve-item survey was completed by seventy-one clinical faculty members and analyzed for trends. Faculty report only 28.3 percent of the unacceptable outcome cases they know about. The two most common reasons given for reporting an unusual occurrence were that it would help the institution reduce similar incidents and it would provide an opportunity to share learning experiences. The most common reason given for not reporting an unusual occurrence was not remembering to do so. Faculty members were most willing to present a TOUCH seminar if guaranteed that no negative repercussions would result. Suggestions for increasing participation in both programs include emphasizing their value, modifying the seminar format, providing more reminders, and reassuring against repercussions.
Asunto(s)
Atención Odontológica/normas , Educación en Odontología/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Gestión de Riesgos/métodos , Facultades de Odontología/normas , Actitud del Personal de Salud , California , Recolección de Datos , Docentes de Odontología , Humanos , Errores Médicos , Revisión por Expertos de la Atención de Salud , Control de CalidadRESUMEN
Quality assurance (QA) and risk management (RM) programs are intended to improve patient care, meet accreditation standards, and ensure compliance with liability insurance policies. The purpose of this project was to obtain and disseminate information on whether dental schools integrate QA and RM and what mechanisms have been most effective in measuring accomplishments in these programs. All sixty-five U.S. and Canadian dental schools were sent a twenty-nine-item survey, and forty-six (71 percent) schools responded. The main findings are as follows: 66 percent had a written QA program combined with a QA committee; 95 percent received administrative support; there was wide variation in the makeup of the QA committee; many institutions reported significant changes resulting from the QA program; and over half of the respondents merged QA and RM in some fashion. To develop or maintain an effective QA/RM program, the authors propose the following: obtain active support from the dean; develop goals and mission/vision statements; include trained personnel on the committee; establish wide levels of involvement in the QA program; develop QA measurements to ensure compliance with institutionally developed standards of patient care; and establish continuous cycles of improvement.
Asunto(s)
Atención Odontológica/normas , Garantía de la Calidad de Atención de Salud , Gestión de Riesgos , Facultades de Odontología/normas , Canadá , Humanos , Encuestas y Cuestionarios , Gestión de la Calidad Total , Estados UnidosRESUMEN
Escalating student debt for dental education has led some to speculate that beginning practitioners may undertake procedures that are beyond their competence in an effort to augment practice income. This hypothesis was tested directLy using a data set containing self-reports of practice profiles across a wide range of procedures and debt for education, practice, and personal purposes. Respondents were 113 individuals who had graduated from a private dental school from 1986 to 1997. Conservative dental practice was measured by comparing frequency of commonly and uncommonly performed procedures in the group as a whole against the profile for each respondent. There was no association between educationaL debt and propensity to engage in unconventional procedures. Older dentists and those who felt more competent at the time of graduation were less conservative. Amount of practice debt was a better predictor of unconventional practice than was educational debt.