Oral medicine in regional oral and maxillofacial surgery units: a five-year review.

Introduction This study looks at the amount of oral medicine activity in oral and maxillofacial surgery (OMFS) units in both South East Wales and South West England, and to consider the development of training programmes in oral medicine and OMFS, to determine how to best deliver a service which would benefit patients with oral medicine diagnoses.Materials and methods Following institutional approvals, local OMFS units in South East Wales and South West England collected data from OMFS outpatient clinics to determine what proportion of patient diagnoses fell within the scope of practice of oral medicine.Results In South East Wales in 2017, patients with oral medicine diagnoses formed 45% of total outpatient activity in OMFS outpatient clinics compared to 37% of patients in the South West of England in 2021. Patients with oral medicine diagnoses were predominantly female and in the older age groups.Discussion and conclusions Changing age demographics suggest that the demand for specialist oral medicine services will continue to rise. Outside of the university dental hospital setting, where all UK oral medicine units are currently located, there is a growing need for specialists in oral medicine to work alongside colleagues in OMFS in district general hospitals to provide specialist oral medicine care to an increasingly large and complex patient group, ideally as part of a managed clinical network.

Improving diagnostic specimen management systems in an oral medicine department.

Histological, haematological and microbiological investigations are essential in the field of oral medicine and are a crucial adjunct to clinical findings, often being relied on to obtain a definitive diagnosis. Importantly, in some cases, these investigations can help exclude or confirm the presence of malignancy. This project highlighted some problems regarding labelling and recording of specimens in an oral medicine department and a lack of clear specimen management processes. It aimed to improve specimen management by reducing reported incidents surrounding diagnostic tests. Quality improvement methods such as process mapping were key to understanding the journey of specimens and the departments involved at each stage of the system. Initiatives included a recording log book, staff training, information signage around the clinic and delegation of responsibilities, all of which were implemented over multiple plan, do, study, act (PDSA) cycles. The project was extremely successful and since implementation there has been a clear and sustained reduction in reported incidents. The small number of incidents which did occur all involved transportation of specimens and none involved labelling or recording. One can conclude that the change in test management systems in terms of recording and labelling of specimens in the department has been sustained. Ongoing engagement with stakeholders and senior leaders is the priority to ensure further reduction in incidents in the future and that the improvements are maintained. This project demonstrates how simple, realistic, cost-effective, quality improvement initiatives can have a significant positive impact on patient care and hospital management systems.