Patient Complaint Generated Case Review Format

The following format will govern the procedures to be taken to address written patient complaints concerning issues of clinical treatment performed within the YVFWC dental program.

  1. All written complaints will follow our QA Departments policies.
  1. Once a dentist is made aware of a written complaint, that dentist will forward the following information to the dental director:

Their written response on a Healthcare Incident Report form

A copy of the complete dental chart

Copies of all relevant radiographs

Clinical models (as needed)

  1. The dental director will conduct a chart review based on the following criteria:

Are the radiographs of adequate quality and quantity to have addressed the issues of the patient complaint?

Are the treatment notes of adequate quality and quantity to understand the treatment rendered?

Is there an adequate amount of information in the treatment notes to support the treatment plan or diagnosis?

Is there an appropriate completed medical history? Blood pressure?

Are there any issues involving misdiagnosis or inadequate addressing of a diagnosed problem?

Are there any violations of the state dental law?

Are there any inappropriate comments in the treatment notes?

Is there any defining fact in the chart that clearly supports either the patient or the dentist? (This could be a radiograph or specific treatment record entry.)

If the case involves a poor result from treatment rendered, are there facts to support that the original treatment was adequate?

Do the treatment notes and other chart records back up the patient complaint or the dentist’s response?

  1. After reviewing the chart, the dental director may need to meet with the patient to personally observe and review the treatment rendered.
  1. The dental director may seek a specialist opinion. If a specialist opinion is needed, it will be conducted in the following manner:

The appropriate clinic administrator will arrange an appointment with the patient and a specialist as detailed by the dental director. The cost for this consult will be covered by the clinic.

The specialist will state their opinion of the quality of the treatment in a written report to the dental director.

  1. The Dental Director will meet with the Corporate Risk Manger and the Clinic Administrator to determine if any compensation to the patient is in order.
  1. After a careful review of the evidence, the Dental Director will assign a Peer Review Level and develop an Action Plan (if needed) and write up a report and recommendation to the YVFWC Peer Review Committee.
  • Peer Review Level 1- standard of care was maintained and no adverse outcomes determined
  • Peer Review Level 2- standard of care was maintained; all complications were within the expected range for the difficulty of the procedure
  • Peer Review Level 3- standard of care was not maintained but there was no patient harm determined
  • Peer Review Level 4- standard of care was not maintained and there was patient harm determined
  1. The YVFWC Peer Review Committee will accept, modify or reject the Dental Directors report and make a final determination in the case.