Post-Treatment Care Crucial in Foreign Object Aspiration Incidents

The accidental aspiration or ingestion of foreign objects during dental procedures can occur on occasion. After all, introducing dental instruments, restorative materials and other small dental components into the oral cavity while a patient is in a reclined position naturally creates an element of risk. While preventative measures may reduce the number of incidents, communication about proper post-treatment care is essential to ensure that your patient is provided with guidance for seeking the appropriate care. 

Foreign Objects in Real Practice

Case Study 1:

The Dentists Insurance Company’s Risk Management Advice Line received a call from a dentist seeking advice on a case of accidental aspiration. In this case, a prophy cup dislodged during a routine re-care visit and was aspirated by the patient.

The dentist reported that the patient was taken to the hospital by his wife. When providers at that hospital were unable to remove the prophy cup, he was transferred to a second hospital, where it was successfully removed. The hospital informed the patient and his wife that the dentist’s insurance should be responsible to pay the associated costs as the medical expenses resulted from a dental procedure. The hospital also asserted that they were unable to bill the medical carrier if another party was “at fault.” Given this concerning representation from the hospital, the patient and his wife contacted the office to determine who would be paying these costs. 

A TDIC risk management analyst worked with the dentist to understand how their professional liability policy could address this situation with a “no fault” provision for medical payments up to $10,000. They explained that when an accident causing bodily injury (like aspiration) occurs at the dentist’s premises, the policy can cover necessary and reasonable expenses incurred for medical, surgical and dental services, including required ambulance and hospital costs.

The analyst advised the dentist that the hospital had an obligation to bill the insurance carrier and was not in a position to establish liability or determine who should be responsible for payment of the associated costs. Therefore, once the carrier was billed, the dentist could ask the patient for a copy of their billed out-of-pocket medical expenses, which could then be submitted for review by TDIC’s claims department. The analyst also advised that if the patient began talking about negligent care, pain and suffering or lost wages, the dentist should contact TDIC right away for further counsel.

Case Study 2:

In another case, a dentist was doing an implant procedure when the implant driver fell back, causing the patient to accidentally swallow the driver. The dentist halted the procedure and sent the patient to a nearby hospital emergency room for X-rays and evaluation.

After viewing the diagnostic imaging, the emergency doctors felt that the implant driver posed a risk of perforation of the intestinal wall and admitted the patient for observation until he could be transferred to another hospital for surgery to remove the implant. This was reported to the dentist by the patient’s wife.

Out of concern for their patient’s well-being, the dentist and an assistant went to the hospital to visit him. The patient and his wife were glad to see them and expressed no ill will towards the practice.

However, when the patient’s adult son encountered the dentist in the hospital room, he did not extend the same warm feelings. The son was very concerned about the accident, and particularly upset that the dentist had allowed his father to drive himself to the emergency room. The son angrily demanded that the visitors leave.

After leaving the hospital, the worried dentist called TDIC’s Advice Line. Along with sharing information about how the dentist’s professional liability policy could assist with the patient’s medical expenses, the analyst referred the dentist to an attorney.

Considering the adult son’s involvement, the analyst cautioned the dentist not to speak with any of his patient’s family members without verification of permission from the patient that should be documented in the patient’s chart.

The analyst suggested that the dentist limit any conversations with the patient to simply expressing an interest in his well-being and wishing him a speedy recovery.

The Aftermath of an Accident

Taiba Solaiman, TDIC senior risk management analyst, reminds dentists that although the outcomes of the above cases are pending, the common denominator is that the providers in both cases took appropriate initial steps by making sure their patients received follow up medical care and contacting the Advice Line for assistance. Taking a proactive stance rather than a “wait-and-see” approach is essential when it comes to patient injuries.

“An incident can happen even if the dentist is very careful,” Solaiman says. “But often, it is how the incident is managed after the event that determines the severity and outcome of the case.”

TDIC recommends dentists take the following actions to help mitigate risks associated with suspected foreign object aspiration or ingestion:

• Stop treatment and assess the situation, even if the incident appears insignificant.
• Stabilize the patient and calmly explain what happened.
• Check the immediate area to locate the object, if possible.
• Refer the patient to their physician or emergency room for follow up and imaging.
• Document the incident and note any witnesses with their contact information. Consult TDIC’s Advice Line and Adverse Occurrence Guide for additional guidance.
• Certain incidents may require reporting to the local dental licensing board. For example, if a patient is hospitalized due to swallowing or aspirating an object during treatment. It is inadvisable to self-report to the dental board. Instead, utilize the expertise of TDIC’s Risk Management Advice Line before reporting. In addition, you may consult the Adverse Occurrence Guide.
• Follow up with patients to check on their recovery. Policyholders and dental association members can sign in to download a Swallowedor Aspirated Object Letter from TDIC’s sample forms.
• Contact your insurance carrier to file an incident report.

“An incident may seem minor to a dentist, but proper follow-up care is essential,” Solaiman added. “Any delay in the proper management and timely intervention of such accidents may cause severe and even life-threatening complications.”

Communication and compassion are key

TDIC emphasizes the importance of communication and compassion in handling patient injuries. Showing compassion is not admitting guilt. Failing to recognize how the patient is feeling or minimizing the situation typically leads to patients becoming more upset. Often what a patient wants is for their dentist to simply express concern and acknowledge the injury.

“A calm, caring attitude and clear communication is key when handling these incidents,” Solaiman says.

A patient may expect that the dentist will offer to cover their copay or other minor expenses as a gesture of good will. However, dentists should contact the Risk Management Advice Line prior to offering or promising any compensatory payments, including gift cards.

Analysts can also help dentists navigate patient demands. However, if an analyst believes the situation could develop into more than a small monetary payment, they may recommend the dentist speak with a claims representative. TDIC’s professional liability policy currently provides coverage up to $10,000 under the medical payments provision for medical expenses related to dental treatment.

Despite the utmost care and precautionary measures, accidents during routine clinical procedures can happen. When they do, it is better for dentists to be armed with the right information and tools that will lead to the most desirable outcomes for patient health and practice reputation.

TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 1.877.269.8844.