Comparison of physicians’ and dentists’ incident reports in open data from the Japan Council for Quality Health Care: A retrospective mixed-method study

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However, there is insufficient evidence of patient safety in the dental field. This study aimed to compare incidents reported by dentists and physicians, compare the type of errors made by them, and identify how dentists prevent dental errors. Methods A retrospective mixed-methods study was conducted using open data from the Japan Council for Quality Health Care database. A total of 6,071 incident reports submitted for the period 2016 to 2020 were analyzed; the number of dentists’ incident reports was 144, and the number of physicians’ incident reports was 5,927. We analyzed the data using descriptive statistics and content analysis. Results The highest percentage of dental incidents reported were treatment errors (n = 104, 72.2%), which was the same as for physicians (n = 3215, 54.2%). The percentage of dental intern reporters was higher than that of medical intern reporters (dentists: n = 12, 8.3%; physicians: n = 180, 3.0%; p = 0.002). The percentage of each type of prevention method utilized was as follows: software 27.8% (n = 292), hardware (e.g., developing a new system) 2.1% (n = 22), environment (e.g., coordinating the activities of staff) 4.2% (n = 44), liveware (e.g., reviewing procedure, double checking, evaluating judgement calls made) 51.6% (n = 542), and liveware-liveware (e.g., developing adequate treatment plans, conducting appropriate postoperative evaluations, selecting appropriate equipment and adequately trained medical staff) 14.3% (n = 150). Conclusions Establishing a comprehensive support system for dental interns is essential. In addition, it is necessary to develop and implement effective preventive methods and policies for patient safety, which not only rely on individual efforts but also engage the medical community as a whole. dentistry adverse event incident report error intern patient safety content analysis SHELL model mixed-methods study Background If medical error was a disease, it would rank as the third leading cause of death in the US [ 1 ], with estimates from developed nations suggesting that between 7.5% and 10.4% of patients in acute care settings experience adverse drug events [ 2 ]. Medical errors affect patients’ quality of life, which can increase the economic burden on society [ 3 ]. Medical accidents, in which patient injuries result from medical care, affect patients in various ways and may also lead to the disruption of an entire healthcare organization. Managing patient safety is one of the elements necessary to advance and continue the development of healthcare organizations. Medical errors leading to adverse events can occur in clusters when mistakes related to overlooking scientific research in respect of new treatments occur. Errors that occur during treatment that are associated with the improper maintenance of equipment and mistakes based on the failure to properly maintain patient records can also result in unfavorable events. Errors arising from the failure to acquire informed consent from a patient, the failure to establish and maintain appropriate infection control measures, and the failure to formulate a proper diagnosis can lead to negative consequences [ 4 ]. In particular, with the increasing number of elderly patients, the prescription of medication has become a complicated task that may lead to errors [ 4 , 5 ]. Currently, general dental practices are carrying out more involved dental procedures and surgeries at their consulting rooms [ 6 ]. Although dental practitioners generally provide complex medical care, little research has been conducted on the safety of dental inpatients. [ 4 – 7 ]. Mortality and significant morbidity associated with the practice of medicine have led to many strategies being developed to help improve patient safety; however, due to its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved [ 8 ]. From a patient safety perspective, a number of peculiarities associated with dentistry serve to distinguish it from other areas of healthcare, particularly from healthcare that is administered within hospitals. To improve quality and safety in dentistry, it was considered necessary to analyze and understand the characteristics of dentistry-specific incidents and to take appropriate measures and educate dental professionals [ 9 ]. Dental care is usually less aggressive than treatment received in hospital and consequently results in comparatively less harm [ 10 ]. Individuals, teams, and systems must work together in the appropriate environment to ensure safety and quality care for patients [ 11 ]. Methods 1) Aim Identifying and recording the occurrence of an incident is the first step in the reporting and learning process [12]. This study aimed to quantitatively compare incident reporting by dentists and physicians and the types of errors made. The qualitative objective was to identify what dentists did to prevent errors. 2) Design A retrospective mixed-methods study was conducted using publicly available data obtained from the Japan Council for Quality Health Care (JCQHC). 3) Data collection This study was conducted using data from the JCQHC. The JCQHC has been collecting incident reports from all over Japan since 2014. The incidents that were analyzed had been reported by 1,512 hospitals in the year 2019. The JCQHC website includes freely available data with respect to reported medical incidents and these data have been the subject of research in previous studies. For example, Akiyama et al. utilized the JCQHC data to investigate incident reports involving hospital administrative staff [13]. Ichikawa et al. researched physicians’ emotions and how this influenced the occurrence of medical errors [14]. This study uses the data from the JCQHC, which includes reports of incidents by physicians and dentists for the period January 2017 to 2019. The data were downloaded from the JCQHC website on August 14, 2020. A total of 6,071 incident reports were collected, of which 144 incidents had been reported by dentists and 5,927 which had been reported by physicians. 4) Analysis These data include quantitative data, such as the characteristics of the incident reports and contextual data, such as a summary of the type of errors made and the hospitals’ safety and prevention policies. To describe the characteristics of incidents reported by dentists, we compared incident reports of physicians and dentists using the χ 2 test and Fisher’s exact test. The statistical analysis was performed using the JMP statistical software (version 12.0), and statistical significance was set at p < 0.05. Two registered nurses, who had experience in content analysis research and the field of hospital management, assisted in analyzing the data. One of the nurses had experience as an administrator of the patient safety department at a hospital, and the other had experience as an administrator of a hospital. Content analysis is useful for examining trends and patterns in documents [15]. One of its major benefits stems from the fact that content analysis is a systematic, replicable technique for condensing many words of text into fewer content categories based on explicit rules of coding [15]. We focused on whether there were policies in place to prevent similar errors from occurring in the future. One of the researchers read the data to gain an overall understanding of the content related to the prevention of similar errors. The data were repeatedly read and divided to achieve immersion and to gain a sense of the whole. One of the researchers then divided the text into units of meaning, after which other researchers carried out the process of division into units of meaning again and this was discussed with two of the other researchers. The researchers discussed the summarized text and units of meaning were identified. The researchers then continued discussion on any units that still presented ambiguity or abstraction, until a consensus was achieved. Discussions continued until all the researchers agreed to the results of the study. The meaning units were organized under the SHELL model, which was developed and advocated principally in aviation literature by Hawkins and Orlady [16]. These components include software (procedure, protocol, and training), hardware (machines, medical equipment and instruments), environment (operating theatre, wards, and consultation rooms), and liveware (doctors, nurses, and other healthcare professionals as well as patients). Liveware involves interrelationships among individuals within and between groups and has two ways in which it can be organized: first, as the person concerned, and second, as the person around the person concerned. We categorized the person concerned as “liveware” and the person around the person concerned as “liveware-liveware.” Results 1) The characteristics of the incidents reported The characteristics of the incidents reported to the JCQHC are listed in Table 1 . The number of incidents reported by dentists to have “occurred on a weekday” was higher than the number of incidents reported by physicians (dentists: n = 140, 97.2%, physicians: n = 5324, 89.8%, p = 0.002) We found that dentists reported that the most common location for an incident to occur was “the outpatient department” (dentists: n = 69, 47.9%, physicians: n = 847, 14.3%, p < 0.001). The highest percentage of incidents reported by dentists took place during treatment (n = 104, 72.2%), which is the same as was reported by physicians (n = 3215, 54.2%). The percentage of incidents reported by dental interns was higher than that of non-dental medical interns (dentists: n = 12, 8.3%, physicians: n = 180, 3.0%; p = 0.002). However, there were no differences in the percentage of reported additional medical care needed as a result of errors made between dentists and physicians. Table 1 Characteristics of the incidents reported Dentists n = 144 n (%) Physicians n = 5,927 n (%) p value Occurring time Weekday 140(97.2) 5324(89.8) 0.002 a Weekend 4(2.8) 603(10.2) Occurring place Inpatient department 75(52.1) 5080(85.7) < 0.001 b Outpatient department 69(47.9) 847(14.3) Report contents Treatment 104(72.2) 3215(54.2) < 0.001 a Medical devices 11(7.6) 146(2.5) Medicine 3(2.1) 584(9.9) Examination 3(2.1) 557(9.4) Drain, tubes 3(2.1) 388(6.5) Others 20(13.9) 1037(17.5) Reporter Medical intern 12(8.3) 180(3.0) 0.002 a Others 132(91.7) 5747(97.0) Additional medical care by errors Needed 127(88.2) 5377(90.7) 0.308 b Not needed 17(11.8) 550(9.3) Incidents reporting year 2017 40(27.8) 1762(29.7) 0.233 b 2018 45(31.3) 2135(36.0) 2019 59(41.0) 2030(34.3) a; Using Fisher’s exact test b; Using χ 2 test 2) Types of errors reported The percentages of all types of errors made are recorded in Table 2 . The percentage of errors reported by dentists relating to the wrong body part receiving treatment was higher than those of physicians (dentists: n = 26, 18.1%, physicians: n = 120, 2.0%). It would appear that dentists were also more likely to leave foreign matter in the body (dentist: n = 15, 10.4%, physicians: n = 182, 3.1%, p < 0.001). The accidental injection percentage was higher among dentists than physicians (dentists: n = 8, 5.6%; physicians: n = 33, 0.6%, p < 0.001), and the foreign body aspiration percentage was also higher among dentists (dentists: n = 8, 5.6%; physicians: n = 33, 0.6%, p = 0.002). Table 2 Type of errors reported Dentist n = 144 n (%) Physicians n = 5927 n (%) p value Wrong treatment 34(23.6) 2318(39.1) < 0.001 Wrong part of body treated 26(18.1) 120(2.0) < 0.001 Leaving foreign matter in the body 15(10.4) 182(3.1) < 0.001 Wrong treatment methods 8(5.6) 447(7.6) 0.520 Accidental injection 8(5.6) 8(0.1) < 0.001 Aspiration of foreign body 5(3.4) 33(0.6) 0.002 Patient misidentification 1(0.7) 25(0.4) 0.465 Others 47(32.6) 2794(47.1) < 0.001 Using χ 2 test 3) Methods utilized to prevent further incidents from occurring The methods that dentists use to try to prevent further incidents from occurring are shown in Table 3 . These methods are related to software, hardware, environment, liveware, and liveware-liveware. In terms of software, we found nine applicable prevention methods, and we examined the top three categories: formulating a manual/rule (n = 108, 37.0%), training/education (n = 96, 32.9%), and attending conferences (n = 28, 9.6%). Concerning hardware, there was only one incident reported and one category defined, developing a new system (n = 22, 100.0%). With regard to environment, there were three categories developed: coordinating the activities of staff (n = 21, 47.7%), improving the physical environment (n = 14, 31.8%), and rearranging the schedule (n = 9, 20.5%). For liveware, we described it as the five most frequent categories: review of procedure (n = 104, 19.2%), double checking (n = 100, 18.5%), evaluating judgement calls made (n = 94, 17.3%), sharing of information (n = 54, 10.0%), and compliance with the rules (n = 49, 9.0%). For liveware-liveware, there were seven categories developed and we examined the most frequent of these: formulating an adequate treatment plan (n = 61, 40.7%), appropriate postoperative evaluation (n = 34, 22.7%), and selecting appropriate equipment or adequately trained medical staff (n = 26, 17.3%). The percentage of each category of method utilized to prevent further incidents is as follows: software 27.8% (n = 292), hardware 2.1% (n = 22), environment 4.2% (n = 44), liveware 51.6% (n = 542), and liveware-liveware 14.3% (n = 150). Table 3 does not include two out of 144 cases (1.4%) involving patient-oriented diseases; these cases were excluded from our analysis and marked as “non-preventable accidents.” Table 3 Methods utilized by dentists to prevent further incidents from occurring n (%) Software 292 (100.0) Formulating a manual and/or rule 108 (37.0) Training and/or education 96 (32.9) Attending conferences 28 (9.6) Doing timeout 19 (6.5) Developing a culture of safety 16 (5.5) Patient engagement 11 (3.8) Report the accident 10 (3.4) Patient education 3 (1.0) Stopping or postponing the operation 1 (0.3) Hardware 22 (100.0) Developing a new system 22 (100.0) Environment 44 (100.0) Coordinating the activities of staff (including the lack of experienced staff, instructors) 21 (47.7) Improving the physical environment 14 (31.8) Rearranging the schedule 9 (20.5) Liveware 542 (100.0) Review of the procedure 104 (19.2) Double checking 100 (18.5) Evaluating judgement calls made 94 (17.3) Sharing of information 54 (10.0) Compliance with the rules 49 (9.0) Verifying observations 35 (6.5) Double checking 29 (5.4) Creating a medical record 19 (3.5) Providing information to the patient 19 (3.5) Paying attention to the patient 18 (3.3) Verbal checking 9 (1.7) Selecting appropriate medication 5 (0.9) Directly consulting senior dentists 4 (0.7) Using appropriate dosage of medication 3 (0.6) Liveware-Liveware 150 (100.0) Formulating an adequate treatment plan 61 (40.7) Appropriate postoperative evaluation 34 (22.7) Selecting appropriate equipment or adequately trained medical staff 26 (17.3) Checking treatment equipment before usage 9 (6.0) Checking equipment during and after use 8 (5.3) Appropriate perioperative management 8 (5.3) Preparation for emergency response 4 (2.7) Discussion In this study, we compared dentists’ and physicians’ incident reporting and the types of errors made and identified what dentists did to prevent errors. Dentists’ reported incidents mostly occurred on weekdays and in the outpatient department during treatment. Of our many findings, we focused on three major results: (1) the percentage of interns who reported incidents was higher among dentists than physicians, (2) there was a difference in the types of incidents reported by dentists and physicians, and (3) reporter-focused prevention methods bias. 1) Dentists’ interns were more likely to report incidents than physicians’ interns Our study revealed that dentists’ interns’ reporting percentages were higher than those of physicians’. Sakuma et al. reported that resident trainee dentists experienced more incidents of a higher level of severity than staff dentists in Japan [ 17 ]. Almost half of the participants who were intern doctors had been assigned to tasks for which they were not trained or for which medical errors could have happened easily [ 18 ]. Medical interns are not only factors in the livewire category, which included missed treatment procedures or missed judgements, but also the environmental category, which included the lack of experienced staff and instructors. Intern doctors are exposed to stress and are at risk of burnout and poor job satisfaction. Therefore, it is necessary to prepare and train in hospitals [ 19 ]. Hospitals are obliged to develop new methods to prevent further incidents from occurring and thereby protecting dental interns from preventable errors. 2) Difference in types of incidents reported by dentists and physicians The characteristics of the incidents reported by dentists related to incorrectness; for example, where the incorrect body part was treated or a wrong treatment was provided. Some patients were treated by primary care dentists in the community, while other patients who experienced treatment complications in community dentists’ consulting rooms were admitted to hospital. The data analyzed in our study were collected from hospitals, and the patients in this study were likely to have been referred to the hospital by a local dental clinic. Studies have shown that diligence and attentiveness falters when a patient is referred to or transferred to another healthcare provider [ 10 ]. In the case of referrals from a clinic to the hospital, the transition will be paper-based, and the patient will utilize a letter of referral. The dentition of the patient is sometimes poor. Referring only to the referral letter may leads to adverse outcomes. To prevent the incorrect body part receiving treatment, it is necessary for patients and their families to be aware of the problem for which they are being referred. It is also worthwhile to take specific data and information, such as X-rays, with you when you are referred to another medical practitioner. In Japan, physicians, nurses, and pharmacists are the main staff members in the patient safety department. However, there are differences between the nature of the incidents reported by dentists and those reported by physicians. Given these circumstances, it is necessary to develop preventive measures specifically for dentists. After collecting all incident reports, the staff of the patient safety department should collaborate with the dental staff to identify, analyze, and assess the risks related to incidents. 3) Reporters focused on human factors, not on software, hardware, or the environment. We identified threats to patient safety when analyzing the dental incident reports as it appeared that the reporter was biased and focused on human methods of prevention. The liveware components of the SHELL model comprised a high percentage of the prevention methods. While patient safety is connected to human factors, it is difficult to prevent serious errors by focusing only on human factors. Our research revealed that prevention methods such as “attending conferences” and “organization of staff”—software and environment components of the SHELL model, respectively—comprised a small percentage of all methods. Reis, Paiva, and Sousa reported that the dimensions of patient safety that proved strongest were “teamwork within units,” while proven weaknesses were “staffing,” “handoffs management and transitions,” and “lack of teamwork across units” [ 20 ]. However, a culture of patient safety must be built to share information and staff across units and departments. We found that the reporters focused on the individual when it came to prevention methods, such as observation, appropriate selection procedure, and judgement. There was a tendency to believe that errors could be prevented by thoroughly checking the following cases, but this method was not sufficient as a measure to prevent the next mistake. Our research revealed that the fundamental solution is to improve the medical staff’s ability to predict risks. This is a systems approach and will assist in the development of a culture of safety. In Japan, “the administrator of hospital, clinic, or birthing center shall undertake measures to ensure safety in medical care in said hospital, clinic, to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare,” this law is defined under the Medical Care Act [ 21 ]. We found that in Japan, serious medical errors occurred in two university hospitals for the period 2010–2014 and in response to this, portions of the Medical Care Act were amended. Changes were made to ensure that the administrator of an advanced medical treatment facility would undertake a high level of governance of said medical facility. The Enforcement Regulations of the Medical Care Act were amended in 2016 to note that the administrator of an advanced medical treatment facility had to assign a particular person as the individual who is responsible for medical safety management and had to establish a department of safety management related to medical care that employs full-time physicians, pharmacists, and nurses [ 22 ]. According to a survey related to the staffing of medical safety management departments that was conducted among 51 national university hospitals, there were no full-time dentists in the patient safety management department [ 23 ]. We found that the incidents reported by physicians and dentists were different. We propose that the patient safety departments in medical facilities should collaborate with dental professionals, such as dentists and dentist hygienists, especially when considering preventive measures, as they require the specific information obtainable only from dental professionals’ files to implement a holistic preventive strategy. Limitations Our findings present the characteristics of incidents reported by dentists and trends in prevention methods in the dental field. However, this study had several limitations. First, the study utilized secondary data from the JCQHC website. The textual data in our study were limited to incident reporters’ descriptions. Due to such a limitation, our findings on the interpretation of methods of prevention are limited, as we were not able to include the background information of hospitals or their staff. Second, the lack of prior research on incidents reported by dentists made it difficult to establish whether the prevention methods shown in our findings were sufficient. Third, the sample size of our study was small. There was a discrepancy in the number of incidents reported by physicians versus the number of incidents reported by dentists. Although the number of incidents reported by dentists was small, dental interns reported a higher percentage of incidents than physicians’ interns. The low number of incidents reported by dentists may be due to the fact that dentists are less likely to experience as many incidents as physicians, but as our data were collected from a secondary source, we cannot put this forward as a finding and would recommend that further research be conducted. Conclusions Our findings revealed that dental interns reported a higher percentage of incidents than that of physicians’ interns. We suggest that hospital administrators and educators need to focus more attention on the systems surrounding dental interns to assist them in error prevention. In addition, we found an imbalance in the prevention methods utilized by dentists. The hard/software and environment components accounted for a small percentage of the errors made, while the components of liveware and liveware-liveware errors were larger. Human error cannot be prevented by individual efforts alone; thus, a systematic and holistic approach needs to be developed by the medical community. Abbreviations JCQHC: Japan Council for Quality Health Care Declarations Ethical approval and consent to participate Not applicable. As this study was conducted using the JCQHC data, which are openly accessible to the public through the internet on the JCQHC website, we did not require ethics approval. Sensitive and confidential information relating to the participants had already been deleted by the JCQHC staff. Consent for publication Not applicable. Availability of data and materials The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Grants-in-Aid for Scientific Research (Grant Number: 20K18889). The funder had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. Authors’ contributions KM and HS conceived of and supervised the study and supervised this work. NA, TA, and TS were responsible for data analysis and interpretation and revisions to the manuscript. NA wrote the main body of the manuscript’s main text. All the authors approved the final version of the manuscript. All authors contributed to the writing of the final manuscript. Acknowledgements We are grateful to Professor Kuniaki Ogasawara for useful inputs to this work. 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Cite Share Download PDF Status: Published Journal Publication published 02 Feb, 2023 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Major revision 28 Nov, 2022 Reviews received at journal 14 Nov, 2022 Reviewers agreed at journal 04 Nov, 2022 Reviews received at journal 17 Oct, 2022 Reviewers agreed at journal 11 Oct, 2022 Reviewers invited by journal 11 Oct, 2022 Editor assigned by journal 23 Sep, 2022 Editor invited by journal 17 Sep, 2022 Submission checks completed at journal 17 Sep, 2022 First submitted to journal 16 Sep, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2072625","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":137389578,"identity":"644d3371-e315-41c5-8ac2-059d19afb2e5","order_by":0,"name":"Naomi Akiyama","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYFACNoYDIIqfvfngAyDNw0e0FsmeY8kGIC1sxGgBA4MbOWYSSHzcwJz9WOJhnppt8kBb0iq/5tjJsDEwP3x0A48Wy560A4d5jt027GdvPnZbdlsy0GFsxsY5eLQYHEhvOMzDdptxJtCW25LbmIFaeNik8Wo5/xyo5d9t+w1AvxRLbqsnQssNoMN4224ngrQwftx2mBgtzxIOzu27nQx0WLI047bjPGzMhPxyPs34w5tvt22B3j/48ee2antgnD58jE8LCDDxQBnMYAYzAeUgwPgDnTEKRsEoGAWjABkAAHiMUUShKXjHAAAAAElFTkSuQmCC","orcid":"","institution":"Gifu University of Health Science","correspondingAuthor":true,"prefix":"","firstName":"Naomi","middleName":"","lastName":"Akiyama","suffix":""},{"id":137389579,"identity":"026737c3-5f48-46a1-a781-bd4fc4a3cef8","order_by":1,"name":"Tomoya Akiyama","email":"","orcid":"","institution":"Nagoya University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomoya","middleName":"","lastName":"Akiyama","suffix":""},{"id":137389581,"identity":"c60abf78-eb1b-4541-815f-e89cb24ae4df","order_by":2,"name":"Hideaki Sato","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hideaki","middleName":"","lastName":"Sato","suffix":""},{"id":137389583,"identity":"7068dcbd-2206-45e4-b483-3815e4580842","order_by":3,"name":"Takeru Shiroiwa","email":"","orcid":"","institution":"NIPH Center for Outcomes Research and Economic Evaluation for Health (C2H)","correspondingAuthor":false,"prefix":"","firstName":"Takeru","middleName":"","lastName":"Shiroiwa","suffix":""},{"id":137389585,"identity":"39bc750a-c5e1-48d9-8696-1c2ced21cdf5","order_by":4,"name":"Mitsuo Kishi","email":"","orcid":"","institution":"Iwate Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mitsuo","middleName":"","lastName":"Kishi","suffix":""}],"badges":[],"createdAt":"2022-09-16 12:29:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2072625/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2072625/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-023-02749-x","type":"published","date":"2023-02-02T18:35:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44718436,"identity":"fd38bd49-f328-46f7-b24b-c397a43103a1","added_by":"auto","created_at":"2023-10-16 18:46:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":371697,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2072625/v1/b9286159-74e3-4f36-bbc4-b458ce7b6c5b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of physicians’ and dentists’ incident reports in open data from the Japan Council for Quality Health Care: A retrospective mixed-method study","fulltext":[{"header":"Background","content":"\u003cp\u003eIf medical error was a disease, it would rank as the third leading cause of death in the US [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with estimates from developed nations suggesting that between 7.5% and 10.4% of patients in acute care settings experience adverse drug events [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Medical errors affect patients\u0026rsquo; quality of life, which can increase the economic burden on society [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Medical accidents, in which patient injuries result from medical care, affect patients in various ways and may also lead to the disruption of an entire healthcare organization. Managing patient safety is one of the elements necessary to advance and continue the development of healthcare organizations.\u003c/p\u003e \u003cp\u003eMedical errors leading to adverse events can occur in clusters when mistakes related to overlooking scientific research in respect of new treatments occur. Errors that occur during treatment that are associated with the improper maintenance of equipment and mistakes based on the failure to properly maintain patient records can also result in unfavorable events. Errors arising from the failure to acquire informed consent from a patient, the failure to establish and maintain appropriate infection control measures, and the failure to formulate a proper diagnosis can lead to negative consequences [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In particular, with the increasing number of elderly patients, the prescription of medication has become a complicated task that may lead to errors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Currently, general dental practices are carrying out more involved dental procedures and surgeries at their consulting rooms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although dental practitioners generally provide complex medical care, little research has been conducted on the safety of dental inpatients. [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMortality and significant morbidity associated with the practice of medicine have led to many strategies being developed to help improve patient safety; however, due to its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. From a patient safety perspective, a number of peculiarities associated with dentistry serve to distinguish it from other areas of healthcare, particularly from healthcare that is administered within hospitals. To improve quality and safety in dentistry, it was considered necessary to analyze and understand the characteristics of dentistry-specific incidents and to take appropriate measures and educate dental professionals [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Dental care is usually less aggressive than treatment received in hospital and consequently results in comparatively less harm [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Individuals, teams, and systems must work together in the appropriate environment to ensure safety and quality care for patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1) Aim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIdentifying and recording the occurrence of an incident is the first step in the reporting and learning process [12]. This study aimed to quantitatively compare incident reporting by dentists and physicians and the types of errors made. The qualitative objective was to identify what dentists did to prevent errors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2) Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective mixed-methods study was conducted using publicly available data obtained from the Japan Council for Quality Health Care (JCQHC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3) Data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted using data from the JCQHC. The JCQHC has been collecting incident reports from all over Japan since 2014. The incidents that were analyzed had been reported by 1,512 hospitals in the year 2019. The JCQHC website includes freely available data with respect to reported medical incidents and these data have been the subject of research in previous studies. For example, Akiyama et al. utilized the JCQHC data to investigate incident reports involving hospital administrative staff [13]. Ichikawa et al. researched physicians\u0026rsquo; emotions and how this influenced the occurrence of medical errors [14]. This study uses the data from the JCQHC, which includes reports of incidents by physicians and dentists for the period January 2017 to 2019. The data were downloaded from the JCQHC website on August 14, 2020. A total of 6,071 incident reports were collected, of which 144 incidents had been reported by dentists and 5,927 which had been reported by physicians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4) Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese data include quantitative data, such as the characteristics of the incident reports and contextual data, such as a summary of the type of errors made and the hospitals\u0026rsquo; safety and prevention policies. To describe the characteristics of incidents reported by dentists, we compared incident reports of physicians and dentists using the \u0026chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003etest and Fisher\u0026rsquo;s exact test. The statistical analysis was performed using the JMP statistical software (version 12.0), and statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eTwo registered nurses, who had experience in content analysis research and the field of hospital management, assisted in analyzing the data. One of the nurses had experience as an administrator of the patient safety department at a hospital, and the other had experience as an administrator of a hospital. Content analysis is useful for examining trends and patterns in documents [15]. One of its major benefits stems from the fact that content analysis is a systematic, replicable technique for condensing many words of text into fewer content categories based on explicit rules of coding [15]. We focused on whether there were policies in place to prevent similar errors from occurring in the future. One of the researchers read the data to gain an overall understanding of the content related to the prevention of similar errors. The data were repeatedly read and divided to achieve immersion and to gain a sense of the whole. One of the researchers then divided the text into units of meaning, after which other researchers carried out the process of division into units of meaning again and this was discussed with two of the other researchers. The researchers discussed the summarized text and units of meaning were identified. The researchers then continued discussion on any units that still presented ambiguity or abstraction, until a consensus was achieved. Discussions continued until all the researchers agreed to the results of the study. The meaning units were organized under the SHELL model, which was developed and advocated principally in aviation literature by Hawkins and Orlady [16]. These components include software (procedure, protocol, and training), hardware (machines, medical equipment and instruments), environment (operating theatre, wards, and consultation rooms), and liveware (doctors, nurses, and other healthcare professionals as well as patients). Liveware involves interrelationships among individuals within and between groups and has two ways in which it can be organized: first, as the person concerned, and second, as the person around the person concerned. We categorized the person concerned as \u0026ldquo;liveware\u0026rdquo; and the person around the person concerned as \u0026ldquo;liveware-liveware.\u0026rdquo;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003cp\u003e\u003cstrong\u003e1) The characteristics of the incidents reported\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe characteristics of the incidents reported to the JCQHC are listed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The number of incidents reported by dentists to have \u0026ldquo;occurred on a weekday\u0026rdquo; was higher than the number of incidents reported by physicians (dentists: n\u0026thinsp;=\u0026thinsp;140, 97.2%, physicians: n\u0026thinsp;=\u0026thinsp;5324, 89.8%, p\u0026thinsp;=\u0026thinsp;0.002) We found that dentists reported that the most common location for an incident to occur was \u0026ldquo;the outpatient department\u0026rdquo; (dentists: n\u0026thinsp;=\u0026thinsp;69, 47.9%, physicians: n\u0026thinsp;=\u0026thinsp;847, 14.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The highest percentage of incidents reported by dentists took place during treatment (n\u0026thinsp;=\u0026thinsp;104, 72.2%), which is the same as was reported by physicians (n\u0026thinsp;=\u0026thinsp;3215, 54.2%). The percentage of incidents reported by dental interns was higher than that of non-dental medical interns (dentists: n\u0026thinsp;=\u0026thinsp;12, 8.3%, physicians: n\u0026thinsp;=\u0026thinsp;180, 3.0%; p\u0026thinsp;=\u0026thinsp;0.002). However, there were no differences in the percentage of reported additional medical care needed as a result of errors made between dentists and physicians.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the incidents reported\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDentists\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;144 n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;5,927 n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccurring time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeekday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140(97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5324(89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeekend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e603(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccurring place\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5080(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e847(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport contents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3215(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical devices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e584(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExamination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e557(9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrain, tubes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e388(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1037(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReporter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical intern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5747(97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAdditional medical care by errors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeeded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5377(90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.308\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot needed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e550(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncidents reporting year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1762(29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.233\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2135(36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2030(34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ea; Using Fisher\u0026rsquo;s exact test\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eb; Using \u0026chi;\u003csup\u003e2\u003c/sup\u003e test\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2) Types of errors reported\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe percentages of all types of errors made are recorded in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The percentage of errors reported by dentists relating to the wrong body part receiving treatment was higher than those of physicians (dentists: n\u0026thinsp;=\u0026thinsp;26, 18.1%, physicians: n\u0026thinsp;=\u0026thinsp;120, 2.0%). It would appear that dentists were also more likely to leave foreign matter in the body (dentist: n\u0026thinsp;=\u0026thinsp;15, 10.4%, physicians: n\u0026thinsp;=\u0026thinsp;182, 3.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The accidental injection percentage was higher among dentists than physicians (dentists: n\u0026thinsp;=\u0026thinsp;8, 5.6%; physicians: n\u0026thinsp;=\u0026thinsp;33, 0.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the foreign body aspiration percentage was also higher among dentists (dentists: n\u0026thinsp;=\u0026thinsp;8, 5.6%; physicians: n\u0026thinsp;=\u0026thinsp;33, 0.6%, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eType of errors reported\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;144 n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;5927 n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWrong treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2318(39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWrong part of body treated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26(18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeaving foreign matter in the body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e182(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWrong treatment methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e447(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAccidental injection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAspiration of foreign body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient misidentification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2794(47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eUsing \u0026chi;\u003csup\u003e2\u003c/sup\u003e test\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3) Methods utilized to prevent further incidents from occurring\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe methods that dentists use to try to prevent further incidents from occurring are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. These methods are related to software, hardware, environment, liveware, and liveware-liveware.\u003c/p\u003e\n\u003cp\u003eIn terms of software, we found nine applicable prevention methods, and we examined the top three categories: formulating a manual/rule (n\u0026thinsp;=\u0026thinsp;108, 37.0%), training/education (n\u0026thinsp;=\u0026thinsp;96, 32.9%), and attending conferences (n\u0026thinsp;=\u0026thinsp;28, 9.6%). Concerning hardware, there was only one incident reported and one category defined, developing a new system (n\u0026thinsp;=\u0026thinsp;22, 100.0%). With regard to environment, there were three categories developed: coordinating the activities of staff (n\u0026thinsp;=\u0026thinsp;21, 47.7%), improving the physical environment (n\u0026thinsp;=\u0026thinsp;14, 31.8%), and rearranging the schedule (n\u0026thinsp;=\u0026thinsp;9, 20.5%). For liveware, we described it as the five most frequent categories: review of procedure (n\u0026thinsp;=\u0026thinsp;104, 19.2%), double checking (n\u0026thinsp;=\u0026thinsp;100, 18.5%), evaluating judgement calls made (n\u0026thinsp;=\u0026thinsp;94, 17.3%), sharing of information (n\u0026thinsp;=\u0026thinsp;54, 10.0%), and compliance with the rules (n\u0026thinsp;=\u0026thinsp;49, 9.0%). For liveware-liveware, there were seven categories developed and we examined the most frequent of these: formulating an adequate treatment plan (n\u0026thinsp;=\u0026thinsp;61, 40.7%), appropriate postoperative evaluation (n\u0026thinsp;=\u0026thinsp;34, 22.7%), and selecting appropriate equipment or adequately trained medical staff (n\u0026thinsp;=\u0026thinsp;26, 17.3%).\u003c/p\u003e\n\u003cp\u003eThe percentage of each category of method utilized to prevent further incidents is as follows: software 27.8% (n\u0026thinsp;=\u0026thinsp;292), hardware 2.1% (n\u0026thinsp;=\u0026thinsp;22), environment 4.2% (n\u0026thinsp;=\u0026thinsp;44), liveware 51.6% (n\u0026thinsp;=\u0026thinsp;542), and liveware-liveware 14.3% (n\u0026thinsp;=\u0026thinsp;150). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e does not include two out of 144 cases (1.4%) involving patient-oriented diseases; these cases were excluded from our analysis and marked as \u0026ldquo;non-preventable accidents.\u0026rdquo;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMethods utilized by dentists to prevent further incidents from occurring\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSoftware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e292 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFormulating a manual and/or rule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e108 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining and/or education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAttending conferences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoing timeout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeveloping a culture of safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport the accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStopping or postponing the operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHardware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeveloping a new system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnvironment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoordinating the activities of staff (including the lack of experienced staff, instructors)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImproving the physical environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRearranging the schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiveware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e542 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReview of the procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDouble checking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvaluating judgement calls made\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSharing of information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompliance with the rules\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerifying observations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDouble checking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCreating a medical record\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProviding information to the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaying attention to the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerbal checking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelecting appropriate medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirectly consulting senior dentists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsing appropriate dosage of medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiveware-Liveware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFormulating an adequate treatment plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppropriate postoperative evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelecting appropriate equipment or adequately trained medical staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChecking treatment equipment before usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChecking equipment during and after use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppropriate perioperative management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreparation for emergency response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we compared dentists\u0026rsquo; and physicians\u0026rsquo; incident reporting and the types of errors made and identified what dentists did to prevent errors. Dentists\u0026rsquo; reported incidents mostly occurred on weekdays and in the outpatient department during treatment. Of our many findings, we focused on three major results: (1) the percentage of interns who reported incidents was higher among dentists than physicians, (2) there was a difference in the types of incidents reported by dentists and physicians, and (3) reporter-focused prevention methods bias.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e1) Dentists\u0026rsquo; interns were more likely to report incidents than physicians\u0026rsquo; interns\u003c/h2\u003e\n\u003cp\u003eOur study revealed that dentists\u0026rsquo; interns\u0026rsquo; reporting percentages were higher than those of physicians\u0026rsquo;. Sakuma et al. reported that resident trainee dentists experienced more incidents of a higher level of severity than staff dentists in Japan [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Almost half of the participants who were intern doctors had been assigned to tasks for which they were not trained or for which medical errors could have happened easily [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Medical interns are not only factors in the livewire category, which included missed treatment procedures or missed judgements, but also the environmental category, which included the lack of experienced staff and instructors. Intern doctors are exposed to stress and are at risk of burnout and poor job satisfaction. Therefore, it is necessary to prepare and train in hospitals [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Hospitals are obliged to develop new methods to prevent further incidents from occurring and thereby protecting dental interns from preventable errors.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e2) Difference in types of incidents reported by dentists and physicians\u003c/h2\u003e\n\u003cp\u003eThe characteristics of the incidents reported by dentists related to incorrectness; for example, where the incorrect body part was treated or a wrong treatment was provided. Some patients were treated by primary care dentists in the community, while other patients who experienced treatment complications in community dentists\u0026rsquo; consulting rooms were admitted to hospital. The data analyzed in our study were collected from hospitals, and the patients in this study were likely to have been referred to the hospital by a local dental clinic. Studies have shown that diligence and attentiveness falters when a patient is referred to or transferred to another healthcare provider [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the case of referrals from a clinic to the hospital, the transition will be paper-based, and the patient will utilize a letter of referral. The dentition of the patient is sometimes poor. Referring only to the referral letter may leads to adverse outcomes. To prevent the incorrect body part receiving treatment, it is necessary for patients and their families to be aware of the problem for which they are being referred. It is also worthwhile to take specific data and information, such as X-rays, with you when you are referred to another medical practitioner.\u003c/p\u003e\n\u003cp\u003eIn Japan, physicians, nurses, and pharmacists are the main staff members in the patient safety department. However, there are differences between the nature of the incidents reported by dentists and those reported by physicians. Given these circumstances, it is necessary to develop preventive measures specifically for dentists. After collecting all incident reports, the staff of the patient safety department should collaborate with the dental staff to identify, analyze, and assess the risks related to incidents.\u003c/p\u003e\n\u003ch2\u003e3) Reporters focused on human factors, not on software, hardware, or the environment.\u003c/h2\u003e\n\u003cp\u003eWe identified threats to patient safety when analyzing the dental incident reports as it appeared that the reporter was biased and focused on human methods of prevention. The liveware components of the SHELL model comprised a high percentage of the prevention methods. While patient safety is connected to human factors, it is difficult to prevent serious errors by focusing only on human factors. Our research revealed that prevention methods such as \u0026ldquo;attending conferences\u0026rdquo; and \u0026ldquo;organization of staff\u0026rdquo;\u0026mdash;software and environment components of the SHELL model, respectively\u0026mdash;comprised a small percentage of all methods. Reis, Paiva, and Sousa reported that the dimensions of patient safety that proved strongest were \u0026ldquo;teamwork within units,\u0026rdquo; while proven weaknesses were \u0026ldquo;staffing,\u0026rdquo; \u0026ldquo;handoffs management and transitions,\u0026rdquo; and \u0026ldquo;lack of teamwork across units\u0026rdquo; [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, a culture of patient safety must be built to share information and staff across units and departments.\u003c/p\u003e\n\u003cp\u003eWe found that the reporters focused on the individual when it came to prevention methods, such as observation, appropriate selection procedure, and judgement. There was a tendency to believe that errors could be prevented by thoroughly checking the following cases, but this method was not sufficient as a measure to prevent the next mistake. Our research revealed that the fundamental solution is to improve the medical staff\u0026rsquo;s ability to predict risks. This is a systems approach and will assist in the development of a culture of safety. In Japan, \u0026ldquo;the administrator of hospital, clinic, or birthing center shall undertake measures to ensure safety in medical care in said hospital, clinic, to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare,\u0026rdquo; this law is defined under the Medical Care Act [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. We found that in Japan, serious medical errors occurred in two university hospitals for the period 2010\u0026ndash;2014 and in response to this, portions of the Medical Care Act were amended. Changes were made to ensure that the administrator of an advanced medical treatment facility would undertake a high level of governance of said medical facility. The Enforcement Regulations of the Medical Care Act were amended in 2016 to note that the administrator of an advanced medical treatment facility had to assign a particular person as the individual who is responsible for medical safety management and had to establish a department of safety management related to medical care that employs full-time physicians, pharmacists, and nurses [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. According to a survey related to the staffing of medical safety management departments that was conducted among 51 national university hospitals, there were no full-time dentists in the patient safety management department [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. We found that the incidents reported by physicians and dentists were different. We propose that the patient safety departments in medical facilities should collaborate with dental professionals, such as dentists and dentist hygienists, especially when considering preventive measures, as they require the specific information obtainable only from dental professionals\u0026rsquo; files to implement a holistic preventive strategy.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Limitations","content":"\u003cp\u003eOur findings present the characteristics of incidents reported by dentists and trends in prevention methods in the dental field. However, this study had several limitations. First, the study utilized secondary data from the JCQHC website. The textual data in our study were limited to incident reporters\u0026rsquo; descriptions. Due to such a limitation, our findings on the interpretation of methods of prevention are limited, as we were not able to include the background information of hospitals or their staff. Second, the lack of prior research on incidents reported by dentists made it difficult to establish whether the prevention methods shown in our findings were sufficient. Third, the sample size of our study was small. There was a discrepancy in the number of incidents reported by physicians versus the number of incidents reported by dentists. Although the number of incidents reported by dentists was small, dental interns reported a higher percentage of incidents than physicians\u0026rsquo; interns. The low number of incidents reported by dentists may be due to the fact that dentists are less likely to experience as many incidents as physicians, but as our data were collected from a secondary source, we cannot put this forward as a finding and would recommend that further research be conducted.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings revealed that dental interns reported a higher percentage of incidents than that of physicians\u0026rsquo; interns. We suggest that hospital administrators and educators need to focus more attention on the systems surrounding dental interns to assist them in error prevention. In addition, we found an imbalance in the prevention methods utilized by dentists. The hard/software and environment components accounted for a small percentage of the errors made, while the components of liveware and liveware-liveware errors were larger. Human error cannot be prevented by individual efforts alone; thus, a systematic and holistic approach needs to be developed by the medical community.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJCQHC: Japan Council for Quality Health Care\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. As this study was conducted using the JCQHC data, which are openly accessible to the public through the internet on the JCQHC website, we did not require ethics approval. Sensitive and confidential information relating to the participants had already been deleted by the JCQHC staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Grants-in-Aid for Scientific Research (Grant Number: 20K18889). The funder had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKM and HS conceived of and supervised the study and supervised this work. NA, TA, and TS were responsible for data analysis and interpretation and revisions to the manuscript. NA wrote the main body of the manuscript\u0026rsquo;s main text. All the authors approved the final version of the manuscript. All authors contributed to the writing of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Professor Kuniaki Ogasawara for useful inputs to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eMakary MA, Daniel M. Medical error\u0026mdash;the third leading cause of death in the US. 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PMID: 25303579.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKimura Y, Tonami KI, Toyofuku A, Nitta H. Analysis of incident reports of a dental university hospital. Int J Environ Res Public Health. 2021;18:8350. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18168350\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePerea-P\u0026eacute;rez B, Santiago-S\u0026aacute;ez A, Garc\u0026iacute;a-Mar\u0026iacute;n F, Labajo-Gonz\u0026aacute;lez E, Villa-Vigil A. Patient safety in dentistry: dental care risk management plan. Med Oral Patol Oral Cir Bucal. 2011;16:e805\u0026ndash;9. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4317/medoral.17085\u003c/span\u003e\u003c/span\u003e. PMID: 21196846.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBailey E, Dungarwalla M. Developing a patient safety culture in primary dental care. 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London: Routledge; 1993.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSakuma Y, Yamamoto S, Yoshikawa K, Watanabe M, Nakajima M. Incidence of clinical mistakes by trainee dentists. J Osaka Dent Univ. 2021;55:251\u0026ndash;4. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18905/jodu.55.2_251\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eStassen P, Westerman D. Novice doctors in the emergency department: a scoping review. Cureus. 2022;14:e26245. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.26245\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eThe Joint Commission. Sentinel Event. A complimentary publication of The Joint Commission, 58; 2017.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eReis CT, Paiva SG, Sousa P. The patient safety culture: a systematic review by characteristics of hospital survey on patient safety culture dimensions. Int J Qual Health Care. 2018;30:660\u0026ndash;77. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/intqhc/mzy080\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMedical Care Act. Law number No 205 of 1984 Amendment of Act No 30 of 2008. Japanese Law Translation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.japaneselawtranslation.go.jp/law/detail/?id=2199\u0026amp;vm=04\u0026amp;re=01\u003c/span\u003e\u003c/span\u003e. Accessed 28 May 2020.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEnforcement Regulation on the Medical Care Act (Tentative translation). Order of the Ministry of Health and Welfare No. 50 of November 5. 1948. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.japaneselawtranslation.go.jp/law/detail_main?re=02\u0026amp;vm=04\u0026amp;id=3653\u003c/span\u003e\u003c/span\u003e. Accessed 28 May 2020.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNational University Hospital Conference Standing Committee. Peer review report between special function hospitals in the first year of Reiwa. (2020-03) (in Japanese). \u003cspan\u003ehttp://\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003enuhc.jp/Portals/0/images/activity/report/sgst_category/safety/peerreview_result2019.pdf\u003c/span\u003e\u003c/span\u003e. Accessed 28 May 2020.\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"dentistry, adverse event, incident report, error, intern, patient safety, content analysis, SHELL model, mixed-methods study","lastPublishedDoi":"10.21203/rs.3.rs-2072625/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2072625/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatient safety is associated with patient outcomes. However, there is insufficient evidence of patient safety in the dental field. This study aimed to compare incidents reported by dentists and physicians, compare the type of errors made by them, and identify how dentists prevent dental errors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective mixed-methods study was conducted using open data from the Japan Council for Quality Health Care database. A total of 6,071 incident reports submitted for the period 2016 to 2020 were analyzed; the number of dentists\u0026rsquo; incident reports was 144, and the number of physicians\u0026rsquo; incident reports was 5,927. We analyzed the data using descriptive statistics and content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe highest percentage of dental incidents reported were treatment errors (n\u0026thinsp;=\u0026thinsp;104, 72.2%), which was the same as for physicians (n\u0026thinsp;=\u0026thinsp;3215, 54.2%). The percentage of dental intern reporters was higher than that of medical intern reporters (dentists: n\u0026thinsp;=\u0026thinsp;12, 8.3%; physicians: n\u0026thinsp;=\u0026thinsp;180, 3.0%; p\u0026thinsp;=\u0026thinsp;0.002). The percentage of each type of prevention method utilized was as follows: software 27.8% (n\u0026thinsp;=\u0026thinsp;292), hardware (e.g., developing a new system) 2.1% (n\u0026thinsp;=\u0026thinsp;22), environment (e.g., coordinating the activities of staff) 4.2% (n\u0026thinsp;=\u0026thinsp;44), liveware (e.g., reviewing procedure, double checking, evaluating judgement calls made) 51.6% (n\u0026thinsp;=\u0026thinsp;542), and liveware-liveware (e.g., developing adequate treatment plans, conducting appropriate postoperative evaluations, selecting appropriate equipment and adequately trained medical staff) 14.3% (n\u0026thinsp;=\u0026thinsp;150).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEstablishing a comprehensive support system for dental interns is essential. In addition, it is necessary to develop and implement effective preventive methods and policies for patient safety, which not only rely on individual efforts but also engage the medical community as a whole.\u003c/p\u003e","manuscriptTitle":"Comparison of physicians’ and dentists’ incident reports in open data from the Japan Council for Quality Health Care: A retrospective mixed-method study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-20 23:18:53","doi":"10.21203/rs.3.rs-2072625/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-28T06:02:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-11-14T12:35:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5127cf23-5d5b-411e-a9a1-020424d20d8d","date":"2022-11-04T16:33:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-17T08:51:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"030f5d54-de86-405a-b7e8-a065bbb6da04","date":"2022-10-11T17:14:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-10-11T17:10:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-09-23T14:55:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-09-17T06:18:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-09-17T06:14:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2022-09-16T12:22:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfeea50e-ec3a-4ed6-a1ba-f14e0bc5b0db","owner":[],"postedDate":"September 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:44:30+00:00","versionOfRecord":{"articleIdentity":"rs-2072625","link":"https://doi.org/10.1186/s12903-023-02749-x","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2023-02-02 18:35:39","publishedOnDateReadable":"February 2nd, 2023"},"versionCreatedAt":"2022-09-20 23:18:53","video":"","vorDoi":"10.1186/s12903-023-02749-x","vorDoiUrl":"https://doi.org/10.1186/s12903-023-02749-x","workflowStages":[]},"version":"v1","identity":"rs-2072625","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2072625","identity":"rs-2072625","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}