Outcomes of a contemporary credentialing and privileging program in a dental school.

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data-based verification process administered by a credentialing specialist can make the process valid and workable.

Rehearsal's effect on long-term recall and comprehension of orthodontic informed consent.

INTRODUCTION: The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices. METHODS: A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later. RESULTS: Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P <0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge >20% was common. CONCLUSIONS: Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Rehearsal's effect on recall and comprehension of orthodontic informed consent.

INTRODUCTION: Proper informed consent allows patients to take an active role in their own treatment decisions, and enhanced compliance might improve treatment outcomes. The objective of this research was to determine if handwritten rehearsal of core and custom consent items would increase short-term recall and comprehension. METHODS: A total of 90 patient-parent pairs were randomly assigned to 2 groups. After case presentation, each subject was provided 10 minutes to read a modified informed consent document. Group A received visual printouts containing the 4 core elements (root resorption, decalcification, pain, and relapse/retention) likely to be encountered by all patients and up to 4 custom elements (eg, impacted teeth, orthognathic surgery, or other case-specific treatment issues). Subjects identified and wrote what the image depicted and how it could affect treatment. Group B viewed a slideshow presentation on all 18 consent elements arranged from general to specific. All participants were interviewed, and each provided their sociodemographic data, as well as completed literacy, health literacy, and state anxiety questionnaires. The groups were compared for recall and comprehension through an analysis of covariance. RESULTS: The rehearsal intervention significantly improved recall and comprehension of the core elements (P = 0.001). Rehearsal also improved custom recall and comprehension, but not significantly. Group B performed significantly better on treatment questions (P = 0.001). Overall, as anxiety increased, correct responses decreased. CONCLUSIONS: The rehearsal group improved recall and comprehension of the core and custom elements of informed consent and proved a more efficient method than an audiovisual presentation to provide informed consent. It also improved meeting legal obligations.

Development and Implementation of a Uniform Dental School-Wide Electronic Treatment Consenting Process for Patients.

One approach to enhancing quality care outcomes and patient safety is through effective implementation of clinical risk reduction strategies. Clinical risk identification at The Ohio State University College of Dentistry revealed lack of a standardized informed consenting process for patients. The purpose of this project was to develop and implement a uniform college-wide informed consenting process. An operating procedure was also developed. The resulting consenting documents used a uniform approach in which clinics could use a basic readable and processable informed consent template. The template was edited for appropriate content suitable for an electronic health record. Implementing an operating procedure along with associated contemporary uniform electronic informed consent forms was realized through efforts of a core team with informed consenting experience. The core team developed the template and the majority of all documents before editing all division-based consents. This method relied on growing expertise and momentum. Outcomes of chart audits following implementation of the new electronic informed consent forms showed a transitory increase in missing consent forms. Subsequently, the number of missing consent forms decreased to near pre-implementation levels. Patient refunds related to missing informed consent issues dropped, and patient satisfaction remained high throughout the project. Other institutions can use this project as a guide for developing their own uniform consent forms and process.