• Jonathan M Stahl, Kelli Mack, Susan Cebula, and Bruce L Gillingham.
• Naval Medical Research Unit San Antonio, 3650 Chambers Pass Bldg. 3610, FT Sam Houston, TX 78234.
• Mil Med. 2020 Feb 12; 185 (1-2): e262-e268.

IntroductionDelivering consistent high quality care in a safe environment is the goal of the modern dental delivery system. Preventable adverse events, however, are still commonplace in dentistry. As has been demonstrated in the medical field, a concerted and persistent effort will be required to objectively understand and begin to eliminate the sources of dental error. In civilian dental practice this effort is hampered by the underreporting of patient safety events in comparison to the medical field. Patient safety reporting in the Military Health System (MHS) is robust and includes dentistry. This provides an important opportunity to analyze these data as the foundation for improvements in dental care and the elimination of preventable harm. The purpose of this article is to review MHS dental patient safety data, identify the primary sources of dental error and describe current initiatives based on the adoption of the High Reliability Organization (HRO) model of care that has been profitably embraced by the medical community.MethodsDental patient safety report data from the Defense Health Agency Patient Safety Analysis Center (PSAC) for the period 2013-2016 were analyzed to determine the type, incidence, contributing factors, setting and trends for dental errors occurring within the MHS. Comparison to medical data was also performed.ResultsFrom 2013 to 2016, there was a 32.1% increase in dental patient safety reports in the MHS. For this period, dentistry accounted for the highest number of Sentinel Events (SEs) compared to other clinical specialties and accounted for 32.7% of all SEs for the period. From 2013 to 2016, there was a five-fold increase in reported dental SEs. Wrong-Site Surgeries (WSS) comprised the highest proportion of SEs followed by intraoperative or immediate post-operative/post-procedure or surgery issues (63% and 14%, respectively). Within the WSS category, wrong-site anesthesia and wrong-tooth treated were the two largest sub-categories (40% and 32%, respectively). The data reviewed are not rates and do not take into account the total number of procedures performed by dentistry in comparison to medicine. Root cause analysis identified communication failures and inconsistent adoption of the Universal Protocol as the leading contributing factors for WSSs.ConclusionSafety initiatives in the dental profession remain immature in comparison to the medical field and the use of an HRO framework is just beginning to emerge in dentistry. The MHS benefits from a robust dental patient safety reporting system when compared to civilian practice in the United States. Review of these data demonstrates that a high priority focus should be the elimination of WSS. Initiatives based on high reliability strategies to address this issue will be discussed. A commitment to reporting and analyzing its performance and adopting the principles and behaviors of HROs will accelerate the MHS goal of providing ever increasing safety and quality in the dental care it provides.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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