Airline safety protocols could aid dentistry

Aug 2, 2010

Implementing a checklist of safety procedures in dental offices similar to procedures used in airlines would drastically reduce human errors, according to three Michigan dentists (Journal of the American Dental Association, August 2010, Vol. 141:8, pp. 1010-1018).

Crew resource management (CRM) empowers team members to actively participate to enhance safety using forward thinking strategies, said Russell Taichman, D.M.D., D.M.Sc., a professor of dentistry and director of the Scholars Program in Dental Leadership at the University of Michigan and paper co-author.

Airlines implemented CRM about 30 years ago after recognizing that most accidents resulted from human error, according to co-author Harold Pinsky, D.D.S., a full-time airline pilot who did additional training at the university's dental school.

CRM checklists in the dentist's office represent a major culture shift that will be slow to catch on, but Dr. Pinsky thinks it's inevitable.

"It's about communication," he said in a university press release. "If I'm doing a restoration and my assistant sees saliva leaking, in the old days the assistant would think to themselves, 'The doctor is king, he or she must know what's going on.' "

But if all team members have a CRM checklist, the assistant is empowered to tell the doctor if there is a problem, according to Dr. Pinsky. "Instead of the doctor saying, 'Don't ever embarrass me in front of a patient again,' they'll say, 'Thanks for telling me,' " he said.

At each of the five stages of the dental visit, the dental team is responsible for checking safety items off a codified list before proceeding. Dr. Pinsky said that while he expects each checklist to look different for each office, the important thing is to have the standards in place.

Studies show that CRM works, the authors noted. Six government studies of airlines using CRM suggest safety improvements as high as 46%. Another study involving six large corporate and military entities showed accidents decreased 36% to 81% after implementing CRM. In surgical settings, use of checklists has reduced complications and deaths by 36%.

Other facilities -- including hospitals, emergency rooms, and nuclear plants -- look to the airline industry to help craft CRM programs, but dentistry hasn't yet adopted CRM, Dr. Pinsky said.

For the next step, the authors hope to design a small clinical trial in the dental school to test CRM, Dr. Taichman said.