Clinical accountability requires measurement. In the 1990’s it became very fashionable and it was actively encouraged within general dental practice to begin audit and to form peer review groups.
At this stage I got heavily involved with a peer review group and started to produce audits of my own work within our oral surgery service and practice. The very first thing I ever did was audit a series of cases of free gingival grafts as a general dental practitioner back in 1997 / 8 and my audits have carried on ever since. I am now the clinical director of a minor oral surgery service within the NHS (and independently) which provides approximately 1200 oral surgery cases per year and we measure our numbers very carefully. In a recent meeting with my clinicians (2 fantastic clinicians who care deeply about their patients) we discussed our complications log which is actively completed in detail for any patient who attends the practice following surgery for an unplanned appointment. We define a complication as someone who has to return unplanned to the practice and in the period from 1st April 2012 to 31st December 2012 we treated over 700 cases at the practice. This is 700 patient cases and therefore included multiple teeth in many cases therefore many more teeth extracted than 700.
At first reading the complication log appears to be just average with 69 entries in the log, including those for multiple cases. Dig a little bit deeper into the data though and this includes 60 appointments for reassurance only and 9 appointments where intervention was required for possible complications. None of the complications listed could be deemed as ‘serious’ with no sensory disturbances following minor oral surgery and no one requiring further treatment at an additional site. The most remarkable part of the log is that over that period antibiotics were prescribed at the practice a total of 8 times.
I will say that again in bold to make sure everyone reads it….. antibiotics were prescribed at the practice a total of 8 times.
This means that if we were to prescribe antibiotics routinely for minor oral surgery we would be unnecessary prescribing in 99% of cases. The main thrust of the discussion between us at the meeting was to reduce the amount of patients attending for routine reassurance appointments following surgery and the key to this is fantastic post-operative advice, explaining to patients that following minor oral surgery they will be in discomfort for upto 7 days and this is normal and should be reasonably well controlled with normal analgesia.
In smokers this period of discomfort can last a fortnight due to the slower healing mechanisms. It is out belief that we can reduce these reassurance appointments by 50% therefore reducing our overall unplanned attendance at the practice to less than 5% following minor oral surgery. This coupled with the fact the interventional treatments following surgery account for less than 1% of cases shows us that our figures are pretty good.
We will continue to keep monitoring.
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