Standardising Interdepartmental Management of Oral Epithelial Dysplasia: A QI Project

Background: Oral epithelial dysplasia (OED) is a histological diagnosis and is related to cellular changes within the oral epithelium that is associated with an increased risk of progression to oral cancer. Risk factors that increase the risk of malignant transformation include smoking, alcohol consumption, site and appearance of the lesion. There are currently no standardised guidelines on the management of patients with OED, however appropriate follow up should be adopted to ensure early detection of oral cancer.

Aim: All patients with OED seen in The School of Dentistry, Belfast will have standardised management.

Methods: A modified version of the Liverpool Algorithm was developed and displayed in all Oral Medicine and Oral Surgery Clinics within the School of Dentistry in Belfast. This was complemented by development of a tick box checklist to be filled in and retained in the patient notes at each appointment. Compliance was measured by logging how many of the check list descriptors were recorded in the patients’ clinical notes.

Results: Baseline data demonstrates that there was an average compliance of 68% in recording clinical determinants and management. The introduction of the checklist increased this to 85% and with further modification to the algorithm and checklist to 92%.

Conclusion: A standardised protocol for patients with OED means that patients will have equitable access to appropriate management and follow up regardless of level of clinician and department the patient attends. Further modification of the checklist is planned, and the intention is to roll this out to other disciplines involved in the management of this patient group in Northern Ireland.