Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model.

BACKGROUND: A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model. METHODS: This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861. RESULTS: We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (ß = -0.074, P = 0.003), responsiveness (ß = -0.148, P = 0.006), and empathy (ß = -0.140, P = 0.011). Furthermore, reliability (ß = 0.655, P < 0.001) and responsiveness (ß = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services. CONCLUSIONS: The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

Dental injury in anaesthesia: a tertiary hospital's experience.

BACKGROUND: Dental injury is a common perioperative complication, but there are no country specific data available, especially with the use of supraglottic airway devices (SAD). The aims of our study are to report the incidence, risk factors, and local practices in the management of perioperative dental injuries in Singapore. METHODS: We analyzed data from the departmental database from 2011 to 2014, noting the anticipated difficulty of airway instrumentation, intubation grade, pre-existing dental risk factors, location of dental trauma discovery, position of teeth injured and presence of dental referral. The risk factors for dental trauma were then identified using logistic regression (between 51 dental trauma patients and 55,107 patients without dental trauma). RESULTS: The rate of dental injury was 0.092% for general anaesthesia cases. The most significant patient risk factor is the presence of pre-existing dental risk factors (OR 12.55). Anaesthetic risk factors include McGrath MAC usage (OR 2.51) and a Cormack and Lehane grade of 3 or more (OR 7.25). Most of the dental injuries were discovered in the operating theatre. 7 (13.7%) patients had SAD inserted and only 23 (45.1%) cases were referred to dental services. CONCLUSION: Videolaryngoscopy with the McGrath MAC is associated with an increased likelihood of dental injury. This could be either because videolarygoscopes were used when increased risk of dental trauma was anticipated, or due to incorrect technique of laryngoscopy. Future studies should be done to establish the causality. The management of dental injuries could be improved with development of departmental guidelines.

A Review of Dental Anatomy and Dental Injury Associated With Anesthesia.

Dental injury during airway management is a common complication encountered during the administration of general anesthesia. This article gives an overview of the frequency of dental injuries, dental anatomy, conditions that increase the risk of dental injury, and mechanism of injury, as well as discusses injury management and avoidance of dental trauma. Although this article does not encompass all situations and variables, it covers these topics in a useful and easily remembered manner that the anesthetist can easily incorporate into practice.

Quality improvement program reduces perioperative dental injuries - A review of 64,718 anesthetic patients.

BACKGROUND: Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program. METHODS: We reviewed the 42-month interval anesthetic records of 64,718 patients who underwent anesthesia. A standardized electronic dental chart was designed to identify any dental prosthetics, fixed and removable dentures, and degree of loose teeth. The incidence of dental injuries associated with anesthesia was separated into three time periods: baseline, initiative (Phase I), and execution (Phase II). Primary outcome measurement was the incidence of PDIs related to anesthesia. RESULTS: The overall incidence of dental injury related to anesthesia was 0.059% (38/64,718 patients). During the baseline period, the dental injury rate was 0.108% (26/24,137 patients), and it decreased from 0.051% in the initiative period (10/19,711 patients) to 0.009% in the execution period (2/20,870 patients) during implementation of the quality improvement program. Most dental injuries were associated with laryngeal mask airway (42.1%) and laryngoscopy (28.9%). The most commonly involved teeth were the upper incisors. CONCLUSION: Dental injury incidence was significantly reduced and remained at low levels after implementation of the quality improvement program. We suggest the implementation of a standardized dental examination into the preoperative evaluation system adding pathologic teeth fixed or protected devices to minimize dental injury associated with anesthesia.