Audit of the workload in a Maxillo-Facial and Oral Surgical Unit in Johannesburg

Abstract

INTRODUCTION Maxillo-facial and oral surgical (MFOS) audits provide data to both current and prospective patients regarding the quality of care an institution is capable of providing. The more frequently performed MFOS procedures can be determined and the allocation of funding and resources can therefore be more appropriately allocated. The scope of MFOS practice that can be determined from an audit may be used for comparison with international trends of practice and for future planning in the training of registrars. AIMS AND OBJECTIVES The aim of the study was to conduct an audit to evaluate the workload and scope of practice of the MFOS unit in the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) for the year 2015 (1st January 2015 to 31st December 2015) by quantifying MFOS conditions and respective treatment modalities for this period. The objectives of the study were to determine the number of patients treated in the unit, their mean age and gender, the spectrum of MFOS activities and scope of practice and to relate this to areas of practice described by Laskin in 2008. METHODS AND MATERIALS The study was a retrospective, cross-sectional study of patients managed in the MFOS unit of the CMJAH. The sample included all patients (in-patients and out-patients) treated in the unit over a one-year period (1st January 2015 to 31st December 2015). Data was retrieved from the statistics of the unit which included a theatre logbook for cases treated under general anaesthesia, as well as a patient register for cases treated under local anaesthesia at the Wits Dental Hospital (located in the CMJAH). The data colleced included patient age, gender,

month of procedure, diagnosis of condition, anatomical site of condition (for trauma and pathology) and the nature of the procedure performed. RESULTS A total of 1,750 patients were treated in the CMJAH MFOS unit during the year 2015. Five hundred and two patients (502) were treated under general anaesthesia while 1,248 patients were treated under local anaesthesia. The male to female ratio was 1.3:1 and the majority of these patients were in their 3rd and 4th decade. Most patients required a tooth extraction mainly for an impacted 3rd molar. Conditions such as trauma, pathology, post-operative complications and sepsis were most commonly encountered. Isolated conditions such as facial deformities, edentulism, partial edentulism and temporo-mandibular joint dysfunction (TMD) were seen on a much lower scale. Dentoalveolar surgery was the most commonly performed procedure followed by the treatment of facial fractures, biopsy of pathological lesions and the incision and drainage of sepsis. Procedures such as jaw reconstructions, jaw resections, soft tissue surgery, orthognathic surgery, implant placements and temporo-mandibular joint (TMJ) surgery were not regularly encountered and only performed under general anaesthesia. The treatment of post-operative complications was also not routinely performed. DISCUSSION The CMJAH MFOS unit treats a high volume of patients in comparisons with global studies. The scope of practice according to areas described by Laskin (2008) is relatively broad, with most procedures being performed in the unit. Certain more advanced MFOS procedures in Laskin’s area of familiarity are not commonly done by registrars due to a low demand and a lack of funding. CMJAH policy also prevents the treatment of certain conditions by the unit, which leads to a slight narrowing of the scope of practice.

CONCLUSIONS In accordance with global workloads and trends, the CMJAH MFOS unit treats a significantly high number of patients as compared with numbers seen on the Asian continent. The scope of MFOS practice is relatively broad with regard to Laskin’s areas of expertise and competence but very narrow in the area of familiarity. We recommend that the workload of the unit might be reduced by training more dental practitioners in primary healthcare procedures. In order to increase their scope of MFOS practice, registrars should devote a fixed amount of time to confering with specialists in private practices who are exposed to advanced MFOS procedures.