Improving management of dental trauma in the emergency department

This project will provide a structured clinical and oral health referral pathway in the emergency department of Sutherland Hospital, for the first aid management of dental trauma.

Aim

By April 2019, 100% of non-admitted dental trauma patients presenting to the emergency department of Sutherland Hospital will follow a structured oral health management process, to support better patient outcomes.

Benefits

• Enhances a comparable prognosis for patients independent of the first aid setting.
• Enhances communication and collaboration between the hospital emergency department and oral health services.
• Improves access to quality care and timely treatment.
• Improves access to oral health services for both patients and hospital emergency staff.
• Streamlines and standardises processes and maximises efficiency.
• Empowers hospital emergency clinical staff.
• Improves satisfaction of patients, emergency staff, and associated oral healthcare providers.
• Potentially reduces costs of dental emergencies.

Background

• Dental trauma can have significant lifelong adverse effects.^1-3
• Timely and appropriate first aid management of these injuries are needed for a good prognosis.⁴
• Many of these patients visit the hospital emergency department for first aid, when dentists are unavailable, and where the environment is not characteristically favorable for ideal management.⁵

Implementation

• A review took place into the electronic medical records that belong to patients with isolated dental trauma injuries who visited the emergency department of Sutherland Hospital for first aid.
• This review confirmed the existence of a problem and identified the cause of the problem. The emergency department at Sutherland Hospital lacks a standardised process of care for isolated dental trauma injuries, with varying assessment, management and referral patterns that are clinician dependent.
• Next, a literature review was carried out to compare the review findings with existing information on the subject. This helped to identify existing best practices.
• Working party consultation then took place, which involved face to face discussions with key stakeholders and clinicians, and a consumer survey.
• Stakeholder discussion revealed the need for a standardised oral healthcare pathway for dental trauma patients attending the emergency department of Sutherland Hospital, the availability of standardised guidelines in the management of such patients, and frequent in-house training for emergency department personnel.
• Solution testing is expected to take place by September, 2019. The solutions include:
  • develop a structured clinical referral pathway for dental trauma in the emergency department at Sutherland Hospital
  • provide video access on dental trauma treatment to clinical personnel of the emergency department at Sutherland Hospital
  • provide a poster or brochure displaying standardised dental trauma guidelines for clinical personnel in the emergency department of Sutherland Hospital.
• Evaluation will be completed in the first quarter of 2020.

Status

Implementation: The initiative is ready for implementation, is currently being implemented, piloted or tested.

Dates

• Start date: July 2018
• End date: February 2020

Implementation sites

• Sutherland Community Dental NSW Health Service, South Eastern Sydney Local District
• Emergency department at Sutherland Hospital, South Eastern Sydney Local District

Partnerships

• Clinical Excellence Commission. Clinical Leadership Program
• Westmead Centre for Oral Health, Western Sydney Local Health District
• University of Sydney, Faculty of Dentistry

Evaluation

Electronic medical records and questionnaires will help to measure problems and outcomes of the project, at baseline and the evaluation stages.

References

1. Andersson L, Malmgren B. The problem of dentoalveolar ankylosis and subsequent replacement resorption in the growing patient. Australian endodontic journal : the journal of the Australian Society of Endodontology Inc. 1999;25(2):57-61.
2. Lee JY, Divaris K. Hidden consequences of dental trauma: the social and psychological effects. Pediatric dentistry. 2009;31(2):96-101.
3. Nguyen PM, Kenny DJ, Barrett EJ. Socio-economic burden of permanent incisor replantation on children and parents. Dental traumatology : official publication of International Association for Dental Traumatology. 2004;20(3):123-33.
4. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental traumatology: official publication of International Association for Dental Traumatology. 2012;28(2):88-96.
5. Alnaggar D, Andersson L. Emergency management of traumatic dental injuries in 42 countries. Dental traumatology: official publication of International Association for Dental Traumatology. 2015;31(2):89-96.

Further reading

• Centre for Oral Health Strategy NSW. Oral Health 2020: A Strategic Framework for Dental Health in NSW. Sydney: NSW Ministry of Health; 2013.
• Hobdell M, Petersen PE, Clarkson J, Johnson N. Global goals for oral health 2020. International dental journal. 2003;53(5):285-8.
• New South Wales Ministry of Health. NSW state health plan: towards 2021. North Sydney: NSW Ministry of Health; 2014.
• Richards D. One billion people have experienced a traumatic dental injury. Evid Based Dent. 2018;19(2):34-5.
• Skapetis T, Gerzina T, Hu W. Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician proficiency? Australasian emergency nursing journal : AENJ. 2012;15(1):14-22.
• The St George Hospital & Community Health Service. Dental Trauma Management. Chatswood, NSW: ACI; 2005.

Contacts