Closed Loop Communication:

No one wants to make a mistake!

by: Dr Larry R. Stewart

According to OMSNIC (our national insurance malpractice carrier), approximately 10 to 15% of professional liability claims reported each year are due to removal of the wrong tooth. In almost all cases, the problem was a result of poor communication either with the referring office, or in the surgeon’s office. We can all agree that treatment plans should be properly communicated between the referring doctor and the OMS! With the increased complexity of surgical procedures performed by oral surgeons including implant surgery, pre-prosthetic surgery, pathology, TMJ and dentofacial deformities, it becomes increasingly important to have clear communication.

The American Heart Association has recognized this problem in team dynamics. They talk about Closed Loop communications. This includes a clear message or order given, and acknowledgment by a clear response with confirmation of understanding, and confirmation of task performance. A direct quote from the 2011 ACLS Professional Provider manual states ” the best teams are composed of members who share a mutual respect for each other and work together in a collegial supportive manner. Clear messages consist of concise communication.”

In an effort to improve communication, the Joint Commission on Hospital Accreditation (JCAHO) has endorsed a wrong site surgery universal protocol. The purpose of this protocol is to reduce the incidence and morbidity of wrong site surgery. The American Dental Association (ADA) has been very supportive in efforts to eliminate wrong site surgery and has worked closely with JCAHO.

Their recommendations are:

  • Review pertinent records and indicate or mark tooth site or surgical site on a diagram or radiograph to be included as part of the patient record.

  • Ensure that radiographs are properly oriented and visually confirm that the correct teeth or tissues have been charted.

  • Conduct a Time-out to verify patient, tooth or procedure with the assistant present who will be participating in the surgical procedure.

We at Texas Oral Surgery Group are committed to the optimal care and treatment of your patients and have worked to see that this protocol is part of our culture of safety. In the busy dental office, it’s not possible for the doctor to personally speak to the OMS about every patient- every time. We understand this, but I’m not sure that our patients do!

As part of Closed Loop Communication and in an effort to provide optimal patient care, we provide offices with a patient referral form to designate the services that you wish for us to provide. This clear line of communication reduces errors and improves patient care, and will even save time because we won’t have to call your office to clarify a treatment request. I encourage you and your staff to utilize these forms. Doing so will better communicate your exact desires for specific treatment, which allows the patient to be assured of the best possible care. In the end, that’s a win-win situation for all parties!


ACLS Provider Manual, American Heart Association 2011 pg. 19.

AAOMS Today, November/December 2003, pg. 3