Lessons learnt on patient safety in dentistry through a 5-year nationwide database study on iatrogenic harm.

Safe delivery of care is a priority in dentistry, while basic epidemiological knowledge of patient safety incidents is still lacking. The objectives of this study were to (1) classify patient safety incidents related to primary dental care in Denmark in the period 2016-2020 and study the distribution of different types of dental treatment categories where harm occurred, (2) clarify treatment categories leading to "nerve injury" and "tooth loss" and (3) assess the financial cost of patient-harm claims. Data from the Danish Dental Compensation Act (DDCA) database was retrieved from all filed cases from 1st January 2016 until 31st December 2020 pertaining to: (1) The reason why the patient applied for treatment-related harm compensation, (2) the event that led to the alleged harm (treatment category), (3) the type of patient-harm, and (4) the financial cost of all harm compensations. A total of 9069 claims were retrieved, of which 5079 (56%) were found eligible for compensation. The three most frequent categories leading to compensation were "Root canal treatment and post preparation"(n = 2461, 48% of all approved claims), "lack of timely diagnosis and initiation of treatment" (n = 905, 18%) and "surgery" (n = 878, 17%). Damage to the root of the tooth accounted for more than half of all approved claims (54.36%), which was most frequently a result of either parietal perforation during endodontic treatment (18.54%) or instrument fracture (18.89%). Nerve injury accounted for 16.81% of the approved claims. Total cost of all compensation payments was €16,309,310, 41.1% of which was related to surgery (€6,707,430) and 20.4% (€3,322,927) to endodontic treatment. This comprehensive analysis documents that harm permeates all aspects of dentistry, especially in endodontics and surgery. Neglect or diagnostic delays contribute to 18% of claims, indicating that harm does not solely result from direct treatment. Treatment harm inflicts considerable societal costs.

The process of litigation for medical errors in Saudi Arabia and the United Kingdom.

Efficient process of litigation of medical errors is a key to ensure fair, speedy, and accessible justice system. The conditions of establishing medical negligence are similar in both legal systems. These conditions include the duty of care, breach of that duty of care, the damages, and establishing causation. A culture of litigation and compensation is growing in the United Kingdom and Kingdom of Saudi Arabia; however the cost of medical claims and awarded compensations are much more in the United Kingdom compared to Kingdom of Saudi Arabia. In Kingdom of Saudi Arabia, there is a need for more transparency in the documentation and publication of litigated medical errors. In addition, there is a need to introduce interventions to shorten the duration of litigation in both legal systems. Financial caps on awarded compensation and caps on expert and legal fees are potential strategies to control the cost of medical errors which seems to work well in the Saudi model.

Understanding the global causes and costs of patient harm.

John Tingle, Reader in Health Law at Nottingham Trent University, discusses the Organisation for Economic Co-operation and Development's report on the economics of patient safety.

Drug-Related Harms in Hospitalized Medicare Beneficiaries: Results From the Healthcare Cost and Utilization Project, 2000-2008.

OBJECTIVES: We examined drug harms in Medicare beneficiaries using the 2000-2008 data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project. RESEARCH DESIGN: This is a cross-sectional study to examine the national estimates of potentially preventable drug-related hospitalizations and in-hospital adverse drug events identified with the International Classification of Diseases codes excluding intentional harms. RESULTS: Hospitalizations related to drug poisoning constituted 0.8% of all Medicare hospitalizations. Annual hospital charges increased from $1.6 billion in 2000 to $4 billion in 2008. In-hospital adverse drug events were noted in 5.3% of all Medicare hospitalizations and increased by 90% from 2000 to 2008. Patients with extreme versus minor loss of function (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.93-2.99) and with extreme versus minor likelihood of dying (OR, 2.30; 95% CI, 2.29-2.33) had increased odds of in-hospital adverse drug events after adjustment for age, sex, and race. The Medicare beneficiaries with more than 5 versus fewer than 5 listed diagnoses had greater odds of in-hospital adverse drug events (OR, 3.79; 95% CI, 3.76-3.82). Each additional diagnosis at discharge was associated with a 13% increase in odds of in-hospital death in the Medicare beneficiaries hospitalized with drug-related diagnoses and with 12% increase in odds of in-hospital death in the Medicare beneficiaries with in-hospital adverse events. CONCLUSIONS: Potentially preventable drug harms are a growing clinical and financial burden. Comparative outpatient drug safety should be analyzed using Medicare claim databases. In-hospital management of drug safety should target patients with multimorbidity and functional decline.

Reducing Harm in Healthcare Systems.

An understanding of the importance of causation of medical errors is important for determining strategies to reduce the harm that they can cause to patients. This paper discusses how dentistry can learn from medicine as well as other industries when developing approaches designed to deal with the causes of errors, rather than their outcomes.

Learning from no-fault treatment injury claims to improve the safety of older patients.

New Zealand's treatment injury compensation claims data set provides an uncommon no-fault perspective of patient safety incidents. Analysis of primary care claims data confirmed medication as the leading threat to the safety of older patients in primary care and drew particular attention to the threat posed by antibiotics. For most injuries there was no suggestion of error. The no-fault perspective reveals the greatest threat to the safety of older patients in primary care to be, not error, but the risk posed by treatment itself. To improve patients' safety, in addition to reducing error, clinicians need to reduce patients' exposure to treatment risk, where appropriate.