This basic-level course discusses the current state of medical/ dental errors and patient safety. Along with highlighting the different types and causes of medical/dental errors, strategies to prevent or control medical/dental errors are presented, and methods of identifying, analyzing, and reporting medical/ dental errors are discussed. The course is intended for all Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing Scope There are many types of medical/dental errors, ranging from minor ones to those that result in serious consequences and possibly death. The Health and Medicine Division (HMD; previously the Institute of Medicine) of the National Academies published a landmark report in 2000 that highlighted the extent of medical/dental errors in the United States. According to the HMD report To Err Is Human: Building a Safer Health System, medical – including dental – errors result in injury to 1 in every 25 hospitalized patients and an estimated 44,000 to 98,000 deaths per year (Kohn, Corrigan, & Donaldson, 2000). If we use the lowest estimate of 44,000 annual deaths, medical/dental errors rank eighth as a leading cause of death in the United States (AHRQ, 2000). More Americans die annually due to medical errors than traffic accidents (Obadan, Ramoni, & Kalenderian, 2015). Because exclusive data on dental errors are limited, it is necessary to rely on risk management data from the medical field to reach conclusions about the extent of errors in dental practice. Medical/dental errors cost the U.S. economy billions of dollars annually (Kohn et al., 2000). Preventable medical/dental errors that occur during or after surgery may cost employers nearly $1.5 billion a year (AHRQ, 2008). In 2008, medical/dental errors cost the United States $19.5 billion (Andel, Davidow, Hollander, & Moreno, 2012). For Medicare beneficiaries alone, between the years of 2006 and 2008, patient safety events were associated with $8.9 billion in excess costs (Reed & May, 2010). Because these numbers come exclusively from hospital-based studies, adding the impact of errors in ambulatory clinics, nursing homes, and other settings would greatly increase these figures. These
dental professionals, including general dentists and dental specialists, dental hygienists, and dental assistants. This course is not designed to give legal advice. Rather, its purpose is to provide dental professionals with information on current issues in medical/dental errors and patient safety.
implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
OVERVIEW
costs do not include the personal cost of patient suffering that results from medical/dental errors. Much of the foundational patient safety work in dentistry has been conducted in the acute care setting. The safety of care in ambulatory settings like the dental office is understudied, even though it is the far more common setting for care. Approximately 65% of the American population sees a dentist at least once per year (Kaiser Family Foundation, 2014) and dental care expenses exceed $100 billion annually in the United States (Wall, Nasseh, & Vujicic, 2014). It is difficult to quantify the cost of dental errors because most occur in private practice settings and are corrected without reporting. The majority of the approximately 200,000 dentists in the United States work in sole proprietorships, in which individual dentists own their practices (ADA, 2012). By contrast, fewer than 20% of physicians are in solo practices, with more than a quarter in practices with more than 100 physicians (Welch, Cuellar, Stearns, & Bindman, 2013). Dental insurance has evolved separately from medical insurance, and federal and state assistance for dental care is limited (Bloom & Cohen, 2010). The only monetary data concerning dental errors comes from lawsuits filed and claims paid. At least one dental malpractice insurance company maintains a website with current dental malpractice information, monetary awards, and case studies (http://www.dentists-advantage.com/sites/DA/rskmgt/casestudy/ Pages/CaseStudyIndex.aspx). usually the result of adverse events. Malpractice is any improper treatment or lack of treatment by a medical or dental healthcare provider that violates generally accepted medical/dental standards of care. In a 2004 article, “The Standard of Care in Dentistry,” in The Journal of the American Dental Association, Joseph P. Graskemper, DDS, JD, relied on the 1970 decision of the Kentucky Court of Appeals in Blair v. Eblen to define the standard of care in dentistry: “[A dentist is] under a duty to use that degree of care and skill which is expected of a reasonably competent [dentist] acting in the same or similar circumstances” (see Blair v. Eblen , 461 S.W. 2d 370, 373, KY, 1970; Justia, n.d.). In successful malpractice claims, the medical/dental healthcare provider’s provision of care is determined to have departed from the standard of practice and resulted in harm to the patient. In order to address the issue of patient safety, dental healthcare providers must comprehend the complexity of these problems,
The language used in the study of medical/dental errors and patient safety The HMD report (Kohn et al., 2000) defines error as “the failure to complete a planned action as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning)” (p. 4). Several terms, such as adverse event (AE), sentinel event, malpractice, and standard of care, are used in the study of medical/dental errors and patient safety issues. An adverse event is defined as an injury to a patient resulting from poor medical management by a healthcare provider or equipment malfunction that results in serious injury or death. Each year, an estimated 3% to 4% of all patients who receive health care are involved in an AE. More specifically, an AE in dentistry would be defined as an injury to a patient resulting from poor dental management provided by a dental healthcare provider or from an equipment malfunction that results in patient injury or death. An AE that is caused by operator error and was preventable is called a sentinel event. Preexisting medical or dental conditions do not lead to AEs. Charges of malpractice are
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Book Code: DFL3024
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