P001: IMPACT OF ANESTHESIA LEARNERS ON DENTAL INJURY IN A LARGE COMMUNITY-BASED HEALTHCARE SYSTEM
Kevin Lukose, MD1; Melanie Warheit, DNP, APRNBC2; Rebecca Andress, MSN, APRNBC2; Gwendalyn Grant, MSN, APRNBC2; Ryan Stalder, MD1; Phillip Cifuentes, MD1; Aaron Wong, MD1; Benjamin T Houseman, MD, PhD, FASA2
1Memorial Healthcare System; 2Envision Physician Services
INTRODUCTION: Dental injury negatively impacts care experience and represents one of the most common claims filed against anesthesia clinicians (1-3). Literature estimates an incidence of dental injury between 0.02-0.07% (1-3). Injuries are frequently associated with poor dentition and endotracheal intubation, but little is known about the impact of learners in these cases. This abstract analyzes dental injuries that occurred between 2023 and 2024 in a large community-based healthcare system with multiple learner programs.
METHODS: We analyzed reports of dental injury at five facilities in our healthcare system during 2023 (67120 total cases) and 2024 (69120 total cases). Inidividual records were reviewed to determine anesthesia type, airway device utilized, involvement of learners (medical student, AA student, SRNA, resident), anticipated difficulty of airway, emergency status, and dentition at risk.
RESULTS: In both 2023 and 2024, a total of 14 dental injuries were reported, representing a rate of 0.02% (Figure 1). Airway manipulation was implicated In about 75% of reported cases, while the cause of remaining 25% was less clear. In both years, the most significant risk factor for injury was "at risk" dentition. This category included loose or chipped teeth as well as temporary or permanent dental appliances. The majority of cases involved general endotracheal anesthesia, but injury following LMA use did occur in both 2023 and 2024. In 2024, four injuries were reported following bronchoscopy, TEE and upper endoscopy under MAC anesthesia at our tertiary referral center.
The participation of anesthesia learners was an uncommon finding in our dataset, with only 2 cases (SRNA, AA student) in 2023 and 1 case (SRNA) in 2024. Only one of these cases attributed injury to airway management; one was related to a bite block and the other was unclear. Very few cases utilized video laryngoscopy, had an anticipated difficult airway, or had an E modifier for ASA physical status.
DISCUSSION: The low rate of injury, high incidence of dentition at risk, and high incidence of direct laryngoscopy in our dataset is consistent with previously published literature (1-3). There were relatively few cases in which learners participated in airway management, but we believe that supervisors may have excluded these inexperienced clinicians from airway management in patients with at risk dentition.
Our study has several limitations. First, our data relies on clinician and/or patient reporting of incidents, so there may be additional events not reported in our system. Second, documentation of medical student and emergency medicine resident participation in our EMR is less robust than resident, AA student, and SRNA. Finally, the low incidence of events makes it difficult to identify trends.
Between 2023 and 2024, all anesthesiology clinicians were required to complete a risk module on dental protection. Learners were not included. We believe that this work did reduce injury in 2024 because 4 of our 14 cases had no anesthesia airway management. In late 2024, a “notable events” reporting system was created to improve data capture, and we look forward to analyzing our system data for 2025.
1. doi: 10.3390/jcm12165343
2. doi: 10.1186/s12871-018-0569-6
3. https://doi.org/10.1016/j.mpaic.2023.05.004
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