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

综述：在美国，每年有超过19.5万名活跃的牙医为127多名牙医提供护理 100万患者，每年花费超过1170亿美元。在这样做的过程中，他们通常表现得很好 复杂环境中的技术和高风险程序，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渴望为其提供高质量、安全的护理的系统 病人。这些系统没有达到这个目标--甚至到了病人死亡的地步。我们一直在 有动力关注牙科患者的安全，因为在这一领域几乎没有做什么。我们的调查人员 患者安全工作表明，对患者的伤害在牙科领域是司空见惯的。通过支持 NIH(R01DE022628)，我们开发并测试了一个患者安全工具包(PST)，用于 记录牙科环境中的不良事件(AE)。利用这个PST，我们开发了一个数据 系统地将牙科AE组织成可搜索的数据库和牙科AE类型的储存库 严重程度分类系统。此外，我们还估计了牙科不良反应的发生率和对 AHRQ(R01HS024406)中大规模图表回顾的差异人群。我们的长期目标是 建立可持续的牙科学习健康体系，注重持续质量改进和 为患者提供安全有效的口腔保健。此应用程序目标是推进 牙科患者安全倡议(PSI)通过将我们的发现从牙科AEs的识别转化为 在两个大型学术牙科机构实施学习实验室。使用系统工程 开放式广泛学习实验室(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防止它们。应用从我们的前辈那里学到的教训 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。该计划将为网站配备容量和工具 识别、调查和解决患者安全事件。我们将在两个月内开发和测试这一倡议 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，我们识别和理解 常见牙科不良事件的促成因素(进行问题分析)。在AIM 2 我们设计和开发改进策略，以防止不良事件发生，使用基于系统的人- 以设计流程为中心。在目标3中，我们在2个机构实施和评估改进策略 并使用阶梯楔形、随机分组的方法评估它们对近端和远端预后的影响 对照试验。我们期待牙科患者安全学习实验室的发展将ARM 具有减少牙科诊所不良反应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.