Open Wide Learning Lab (OWLL): Improving Patient Safety in Dentistry

摘要：在美国，每年有超过 195,000 名在职牙科医生为超过 127 名患者提供护理服务。 百万患者，每年花费超过 1170 亿美元。通过这样做，他们通常表现出色 复杂环境中的技术和风险程序、团队合作并使用多种设备 和工具。每个牙科诊所都代表着一个致力于为其提供高质量、安全护理的系统 患者。这些系统未能实现这一目标，甚至导致患者死亡。我们曾经 由于在这方面做得很少，因此有动力关注牙科患者的安全。我们的调查 患者安全工作表明，对患者造成伤害在牙科领域很常见。通过支持 根据 NIH (R01DE022628) 的要求，我们开发并测试了患者安全工具包 (PST)，用于 记录牙科环境中的不良事件 (AE)。使用此 PST，我们开发了一个数据 存储库将牙科 AE 系统地组织到可搜索数据库和牙科 AE 类型中 严重程度分类系统。此外，我们还估计了牙科 AE 的发生率及其对 通过 AHRQ 中的大规模图表审查来确定人口差异（R01HS024406）。我们的长期目标是 建立一个可持续的牙科学习健康系统，专注于持续的质量改进和 为患者提供安全有效的口腔保健。该应用程序的目的是推进 牙科患者安全倡议 (PSI)，将我们的发现从牙科 AE 的识别转化为 在两家大型学术牙科机构建立学习实验室。使用系统工程 通过这种方法，开放广泛学习实验室 (OWLL) 将系统地识别牙科患者安全面临的威胁 并反复测试改进策略以预防它们。应用我们之前的经验教训 工作中，我们的团队具有独特的优势，可以通过开发可扩展的、基于系统的和 多机构牙科患者安全学习实验室。该计划将为站点配备能力和工具 识别、调查和解决患者安全事件。我们将在两点开发和测试这一举措 德克萨斯州和加利福尼亚州的大型牙科学术中心。在目标 1 中，我们确定并理解 常见牙科不良事件的影响因素（进行问题分析）。目标 2 我们设计和开发改进策略，使用基于系统的人力来预防不良事件 以设计流程为中心。在目标 3 中，我们在 2 个机构实施并评估改进策略 并使用阶梯楔形、聚类随机评估它们对近端和远端结果的影响 对照试验。我们期望牙科患者安全学习实验室的发展将有助于 拥有减少牙科诊所不良事件发生的知识和技术的机构。

Summary: Each year in the US, over 195,000 active dental practitioners provide care to more than 127 million patients, expending more than $117 billion annually. In so doing, they routinely perform highly technical and risky procedures in complex environments, work in teams and use a multitude of devices and tools. Each dental clinic represents a system that aspires to provide high quality, safe care to its patients. These systems fall short of that goal – even to the point of patient death. We have been motivated to focus on dental patient safety because little had been done in this arena. Our investigative patient safety work has shown that harms to patients are commonplace in dentistry. Through the support of the NIH (R01DE022628), we have developed and tested a Patient Safety Toolkit (PST) for documenting adverse events (AEs) in the dental setting. Using this PST, we have developed a data repository to systematically organize dental AEs into a searchable database and dental AE type and severity classification systems. Further, we have estimated the incidence of dental AEs and impact on disparity populations through large scale chart reviews in AHRQ (R01HS024406). Our long-term goal is to build a sustainable dental learning health system focused on continuous quality improvement and providing patients with safe and effective oral healthcare. The objective of this application is to advance the dental Patient Safety Initiative (PSI) by translating our findings from identification of dental AEs to implementing a learning laboratory at two large academic dental institutions. Using a systems engineering approach, the Open Wide Learning Lab (OWLL) will systematically identify threats to dental patient safety and iteratively test improvement strategies to prevent them. Applying the lessons learned from our prior work, our group is uniquely positioned to advance the PSI by developing a scalable, systems-based and multi-institutional dental patient safety learning lab. This program will arm sites with the capacity and tools to identify, investigate, and address patient safety incidents. We will develop and test this initiative at two large dental academic centers in Texas and California. In Aim 1 we identify and understand the contributing factors (conduct problem analysis) for commonly occurring dental adverse events. In Aim 2 we design and develop improvement strategies to prevent adverse events using a systems-based human- centered design processes. In aim 3 we implement and evaluate improvement strategies at 2 institutions and evaluate their impact on proximal and distal outcomes using a stepped-wedge, clustered randomized control trial. We expect that the development of the Dental Patient Safety Learning Lab will arm institutions with both the knowledge and know-how to reduce the occurrence of AEs in dental clinics.