Applying the Concept of Standard Work to Inpatient Dental Consultations

Abstract

Introduction: The concepts of standardizing work processes and continuous process improvement (CPI) have spread from manufacturing into other disciplines, including healthcare. CPI focuses on analyzing processes, identifying problems, standardizing repeatable elements, and testing results. The Department of Dentistry at Seattle Children’s Hospital (SCH) identified dental inpatient consultations as an area to implement standardization to achieve improvements and introduced a standard dental consultation tool, the DCT, in 2009. An important part of CPI is reanalyzing workflow after change such as the DCT, are introduced. Objectives: This study was designed to assess the use of the DCT at SCH. The primary objectives were: 1) to describe inpatient dental consultations at SCH, 2) to determine the frequency of use of the DCT at SCH, 3) to examine associations between DCT use and types of information documented in the consultation note, and 4) to evaluate the effectiveness of the DCT by comparing dental outcomes in consultations that utilized the DCT to consultations that did not utilize the DCT. Methods: This study is a retrospective chart review of all inpatient dental consultations at SCH between May 1, 2009 and May 31, 2013. Descriptive statistics were calculated for all variables. Associations with types of data documented in the consultation and whether the DCT was utilized was tested using a Chi-square Test or a Fisher’s Exact Test. Results: A total of 632 consultations were included in the study, with 354 using the DCT (61.2%). The most frequent requesting service for the consultations was Hematology-Oncology (50.6%) and the most frequent reason for a dental consultation request was baseline consultation (47.3%). Caries (23.6%) was the most frequent dental pathology identified. Data related to caries risk assessment were frequently omitted from consultation notes when the DCT was not used. It was not possible to analyze patient outcomes following dental consultation due to data limitations. Conclusion: The DCT was used during 61.2% of all consultations and for 69.8% of baseline consultations. Use of the DCT most improved documentation of factors key to caries risk assessment. As a result of this study, the SCH Department of Dentistry is modifying the DCT to improve ease of use, creating a second DCT specific to problem-focused dental consultations, and exploring methods to improve tracking of patients with dental needs identified during the consultation. The evolution of the DCT at SCH is an example of using CPI principles to improve patient care.