title: Systematic review of patient safety interventions in dentistry.
abstract: BACKGROUND
  The concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve patient safety or to minimise the occurrence of adverse events.
  
  
  METHODS
  The aim of this qualitative systematic review was to search the academic and grey literature to identify and assess tools or interventions used in dental care settings to maintain or improve patient safety. All study designs were included from all dental care settings. Outcome measures were: patient safety, harm prevention, risk minimization, patient satisfaction and patient acceptability, professional acceptability, efficacy, cost-effectiveness and efficiency. Quality assessments were performed on the included studies based on CASP tools. Further analysis was undertaken to discover whether any of the tools had been trialled or verified by the authors, or by subsequent authors.
  
  
  RESULTS
  Following abstract screening, and initial qualitative synthesis, nine studies were found to meet the inclusion criteria with 31 being excluded following initial analysis. Tools identified included: checklists (4 studies), reporting systems (3), the use of electronic notes (1) and trigger tools (1). Grey literature searching did not identify any further appropriate studies. In terms of study design, there were observational studies including audit cycles (5 studies), epidemiological studies (3) and prospective cluster randomised clinical trials (1). The quality of the studies varied and none of their outcomes were verified by other researchers. The tools identified have the potential to be used for measuring and improving patient safety in dentistry, with two surgical safety checklists demonstrating a reduction in erroneous dental extractions to nil following their introduction. Reporting systems provide epidemiological data, however, it is not known whether they lead to any improvement in patient safety. The one study on trigger tools demonstrates a 50 % positive predictive value for safety incidents. It is not clear as to what impact the introduction of electronic guidelines has on patient safety outcomes.
  
  
  CONCLUSIONS
  This systematic review finds that the only interventions in dentistry that reduce or minimise adverse events are surgical safety checklists. We believe this to be the first systematic review in this field; it demonstrates the need for further research into patient safety in dentistry across several domains: epidemiological, conceptual understanding and patient and practitioner involvement.
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK. Edmund.bailey@manchester.ac.uk.
authors.forename: Edmund
authors.initials: E
authors.lastname: Bailey
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK. martin.tickle@manchester.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health - Centre for Primary Care, University of Manchester, 7th Floor: Williamson Building, Manchester, M13 9PL, UK. Stephen.campbell@manchester.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.affiliation: School of Dentistry, University of Manchester, J R Moore Building, Oxford Road, Manchester, M13 9PL, UK. lucy.omalley@manchester.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: O'Malley
mesh_terms: D003362:Cost-Benefit Analysis; D003813:Dentistry; D006801:Humans; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic