Abstract
Background: Effective incident reporting systems (IRS) are essential in dentistry for identifying and preventing adverse events (AEs), with standardized classifications ensuring consistent incident categorization. This study aimed to develop and validate a classification system for dental patient safety incidents based on a 5-year case study at the Dental Hospital at Chulalongkorn University, Thailand.
Methods: An iterative qualitative approach was used. A literature review explored existing accreditation standards and AE classification systems. Incident reports from 2018–2022 informed a draft classification system aligned with Thailand’s National Reporting and Learning System and accreditation standards. Reports from 2023 were used for validation. An expert panel assessed the system using a 7-point Likert scale.
Results: A total of 1,618 incident reports were analyzed, with 752 classified as safety incidents in patients with dental problems. The finalized system consisted of 28 main categories and multiple subcategories. The top three reported patient safety incidents were medical record errors, accidental damage, and post-operative complications. Expert evaluations demonstrated strong consensus on the system's relevance and comprehensiveness.
Conclusions: The developed comprehensive classification system is adaptable across various dental care settings, providing a framework for standardized reporting, data analysis, and improved risk management. This system improves dental care quality by making incident reporting more accurate and consistent. More research is needed to see its long-term impact on patient safety and how it fits into a full reporting system.
Keywords: Dental patient safety, Dental adverse events, Incident reporting system, Dental risk management, Classification system, Dental quality improvement
Recommended Citation
Siriwatana K, Pongpanich S.
Classification of Dental Adverse Events Using Iterative Qualitative Analysis.
J Health Res.
2025;
39(4):-.
DOI: https://doi.org/10.56808/2586-940X.1149
References
[1] World Health Organization. World alliance for patient safety: WHO draft guidelines for adverse event reporting and learning systems: from information to action. Geneva: World Health Organization; 2005.
[2] Perea-Perez B, Labajo-Gonzalez E, Santiago-Saez A, Albarran-Juan E, Villa-Vigil A. Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010. Med Oral Patol Oral Cir Bucal 2014;19(5):e500-5. https://doi.org/10.4317/medoral.19.5.e500.
[3] Vivek P, Md Sofiqul I, Muhammed Mustahsen R, Nallan CSKC, Padma Priya S. Understanding patient safety in dentistry: evaluating the present and envisioning the future a narrative review. BMJ Open Quality 2024;13(Suppl 2):e002502. https://doi.org/10.1136/bmjoq-2023-002502.
[4] World Health Organization. The conceptual framework for the international classification for patient safety. Version 1.1. 2009.
[5] Fukami T, Uemura M, Nagao Y. Significance of incident reports by medical doctors for organizational transparency and driving forces for patient safety. Patient Saf Surg 2020;14(1):1-7. https://doi.org/10.1186/s13037-020-00240-y.
[6] Stavropoulou C, Doherty C, Tosey P. How effective are incident-reporting systems for improving patient safety? A systematic literature review. Milbank Q 2015;93(4):826-66. https://doi.org/10.1111/1468-0009.12166.
[7] Ensaldo-Carrasco E, Suarez-Ortegon MF, Carson-Stevens A, Cresswell K, Bedi R, Sheikh A. Patient safety incidents and adverse events in ambulatory dental care: a systematic scoping review. J Patient Saf 2021;17(5):381-91. https://doi.org/10.1097/PTS.0000000000000316.
[8] Rooney D, Barrett K, Bufford B, Hylen A, Loomis M, Smith J, et al. Data collection for adverse events reporting by US Dental Schools. J Patient Saf 2020;16(3):e126-30. https://doi.org/10.1097/PTS.0000000000000281.
[9] Tokede O, Walji M, Ramoni R, Rindal DB, Worley D, Hebballi N, et al. Quantifying dental office originating adverse events: the dental practice study methods. J Patient Saf 2021;17(8):e1080-7. https://doi.org/10.1097/PTS.0000000000000444.
[10] Obadan EM, Ramoni RB, Kalenderian E. Lessons learned from dental patient safety case reports. J Am Dent Assoc 2015;146(5):318-326.e2. https://doi.org/10.1016/j.adaj.2015.01.003.
[11] Kalenderian E, Obadan-Udoh E, Maramaldi P, Etolue J, Yansane A, Stewart D, et al. Classifying adverse events in the dental office. J Patient Saf 2021;17(6):e540-56. https://doi.org/10.1097/PTS.0000000000000407.
[12] Renton T, Master S. The complexity of patient safety reporting systems in UK dentistry. Br Dent J 2016;221(8):517-24. https://doi.org/10.1038/sj.bdj.2016.782.
[13] Thusu S, Panesar S, Bedi R. Patient safety in dentistry e state of play as revealed by a national database of errors. Br Dent J 2012;213(3):E3. https://doi.org/10.1038/sj.bdj.2012.669.
[14] Organization THAIP. Hospital and Healthcare Standards. fifth ed. Nonthaburi (Thailand): The Healthcare Accreditation Institute (Public Organization); 2022.
[15] Mahoney G. The Australian experience in dental classification. Mil Med 2008;173(suppl.1):15-7. https://doi.org/10.7205/milmed.173.supplement_1.15.
[16] TNRLS. Thailand national reporting and learning system. [cited 2025 April 2]. Available from: https://thai-nrls.org/.
[17] Siriwatana K, Pongpanich S. A 5-year retrospective analysis of adverse events in dentistry at the Dental Hospital, Faculty of Dentistry, Chulalongkorn University. BMC Oral Health 2024;24(1):1294. https://doi.org/10.1186/s12903-024-05034-7.
[18] Siriwatana K, Pongpanich S. Developing and evaluating a dental incident reporting system: a user-centered approach to risk management. BMC Oral Health 2025;25(1):339. https://doi.org/10.1186/s12903-025-05729-5.
[19] The Healthcare Accreditation Institute H. Patient safety goals: SIMPLE Thailand; 2018.
[20] Kimura Y, Tonami K-I, Toyofuku A, Nitta H. Analysis of incident reports of a Dental University Hospital. Int J Environ Res Publ Health 2021;18(16):8350. https://doi.org/10.3390/ijerph18168350.
[21] England N. The 2015-2016 Never Events List 2015/16 2015. Available from: https://www.england.nhs.uk/wp-content/uploads/2015/03/neverevnts-list-15-16.pdf.
[22] Ensaldo-Carrasco ESA, Cresswell K, Bedi R, Carson-Stevens A, Sheikh A. Patient safety incidents in primary care dentistry in England and Wales: mixed methods study. J Patient Saf 2021;17(8):e1383-93. https://doi.org/10.1097/PTS.0000000000000530.
[23] World Health Organization. Conceptual framework for the international classification for patient safety. Geneva:WHO; 2010.
[24] Kalenderian E, Lee JH, Obadan-Udoh EM, Yansane A, White JM, Walji MF. Development of an inventory of dental harms: methods and rationale. J Patient Saf 2022;18(6):559-64. https://doi.org/10.1097/PTS.0000000000001033.
[25] Hsu C-C, Sandford BA. The delphi technique: making sense of consensus. Practical Assess Res Eval 2019. https://doi.org/10.7275/PDZ9-TH90.
[26] Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the delphi method for selecting healthcare quality indicators: a systematic review. PLoS One 2011;6(6):e20476. https://doi.org/10.1371/journal.pone.0020476.
[27] Amrouche T. Delphi technique between the easy theoretic and the difficulty application in scientific research and future studies. Technium Soc Sci J 2022;37(1):749-59. https://doi.org/10.47577/tssj.v37i1.7603.
[28] Nuckols TK, Bell DS, Liu H, Paddock SM, Hilborne LH. Rates and types of events reported to established incident reporting systems in two US hospitals. Qual Health Care 2007;16(3):164-8. https://doi.org/10.1136/qshc.2006.019901.
[29] Weise J, Fisher KR, Trollor J. Utility of a modified online delphi method to define workforce competencies: lessons from the intellectual disability mental health core competencies project. J Pol Pract Intellect Disabil 2016;13(1):15-22. https://doi.org/10.1111/jppi.12142.
[30] Solidoro P, Dente F, Micheletto C, Pappagallo G, Pelaia G, Papi A. An Italian delphi consensus on the triple inhalation therapy in chronic obstructive pulmonary disease. Multidiscip Respir Med 2024;19(1). https://doi.org/10.5826/mrm.2024.949.
[31] Jorm AF. Using the delphi expert consensus method in mental health research. Aust N Z J Psychiatr 2015;49(10): 887-97. https://doi.org/10.1177/0004867415600891.