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

每年在美国，超过195，000名活跃的牙科医生为超过127名患者提供护理。 每年花费超过1170亿美元。在这样做的过程中， 复杂环境中的技术和风险程序，在团队中工作并使用多种设备 和工具.每个牙科诊所都代表着一个系统，致力于为其提供高质量，安全的护理。 患者这些系统达不到这一目标-甚至到了病人死亡的地步。我们一直 由于在这一竞技场中几乎没有做过什么，因此有动力关注牙科患者的安全。我们的调查 病人安全工作表明，对病人的伤害在牙科中是司空见惯的。通过支撑 根据NIH（R 01 DE 022628），我们开发并测试了患者安全工具包（PST）， 记录牙科环境中的不良事件（AE）。使用这个PST，我们开发了一个数据 系统地将牙科AE组织到可搜索的数据库和牙科AE类型中的存储库， 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（R 01 HS 024406）中的大比例尺图表审查的差异人群。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， 为患者提供安全有效的口腔保健。本申请的目的是推进 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 在两个大型学术牙科机构建立学习实验室。使用系统工程 开放式学习实验室（OWLL）将系统地识别对牙科患者安全的威胁 并反复测试改进策略以防止它们。应用从我们以前的经验教训， 工作，我们的小组是独特的定位，以推进PSI通过开发一个可扩展的，基于系统的， 多机构牙科患者安全学习实验室。该计划将为站点提供能力和工具， 识别、调查和处理患者安全事件。我们将在两个月内开发和测试这一举措， 德克萨斯州和加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）。在目标2 我们设计和开发改进策略，以防止不良事件使用系统为基础的人， 以设计过程为中心。在目标3中，我们在2个机构实施和评估改进策略 并使用阶梯楔块、聚类随机 对照试验我们希望牙科患者安全学习实验室的发展将武装 拥有知识和技术诀窍的机构，以减少牙科诊所的AE发生率。

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.