# Open Wide Learning Lab (OWLL): Improving Patient Safety in Dentistry

> **NIH AHRQ R18** · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · 2020 · $624,850

## Abstract

Summary: Each year in the US, over 195,000 active dental practitioners provide care to more than 127
million patients, expending more than $117 billion annually. In so doing, they routinely perform highly
technical and risky procedures in complex environments, work in teams and use a multitude of devices
and tools. Each dental clinic represents a system that aspires to provide high quality, safe care to its
patients. These systems fall short of that goal – even to the point of patient death. We have been
motivated to focus on dental patient safety because little had been done in this arena. Our investigative
patient safety work has shown that harms to patients are commonplace in dentistry. Through the support
of the NIH (R01DE022628), we have developed and tested a Patient Safety Toolkit (PST) for
documenting adverse events (AEs) in the dental setting. Using this PST, we have developed a data
repository to systematically organize dental AEs into a searchable database and dental AE type and
severity classification systems. Further, we have estimated the incidence of dental AEs and impact on
disparity populations through large scale chart reviews in AHRQ (R01HS024406). Our long-term goal is to
build a sustainable dental learning health system focused on continuous quality improvement and
providing patients with safe and effective oral healthcare. The objective of this application is to advance
the dental Patient Safety Initiative (PSI) by translating our findings from identification of dental AEs to
implementing a learning laboratory at two large academic dental institutions. Using a systems engineering
approach, the Open Wide Learning Lab (OWLL) will systematically identify threats to dental patient safety
and iteratively test improvement strategies to prevent them. Applying the lessons learned from our prior
work, our group is uniquely positioned to advance the PSI by developing a scalable, systems-based and
multi-institutional dental patient safety learning lab. This program will arm sites with the capacity and tools
to identify, investigate, and address patient safety incidents. We will develop and test this initiative at two
large dental academic centers in Texas and California. In Aim 1 we identify and understand the
contributing factors (conduct problem analysis) for commonly occurring dental adverse events. In Aim 2
we design and develop improvement strategies to prevent adverse events using a systems-based human-
centered design processes. In aim 3 we implement and evaluate improvement strategies at 2 institutions
and evaluate their impact on proximal and distal outcomes using a stepped-wedge, clustered randomized
control trial. We expect that the development of the Dental Patient Safety Learning Lab will arm
institutions with both the knowledge and know-how to reduce the occurrence of AEs in dental clinics.

## Key facts

- **NIH application ID:** 10001485
- **Project number:** 5R18HS027268-02
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
- **Principal Investigator:** Elsbeth Kalenderian
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $624,850
- **Award type:** 5
- **Project period:** 2019-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10001485

## Citation

> US National Institutes of Health, RePORTER application 10001485, Open Wide Learning Lab (OWLL): Improving Patient Safety in Dentistry (5R18HS027268-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10001485. Licensed CC0.

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