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Section B: Clinical Services

B.1 APPOINTMENT PROCEDURES


PURPOSE

The purpose of this policy is to create a mechanism of efficient scheduling to ensure timely dental services for eligible recipients.




PROCEDURE



Definitions

BROKEN APPOINTMENT:

This is: (1) an appointment that is missed completely, (2) when the patient is more than 15 minutes late by the clinic clock and has not called one full day ahead of the appointment to reschedule.

CANCELED APPOINTMENT:


This is when a patient is unable to come for a scheduled appointment and phones one day in advance to reschedule their appointment.

OPEN ACCESS

Patients are seen without an appointment as they present to the clinic

ROUTINE PATIENT:

This is a patient that has received a scheduled appointment.

SHORT CALL LIST: (When necessary based on demand)

This is a list of patients who have been treatment planned for routine dental services. Due to the inability of the clinic to meet the demand for patient care in the past, the list will serve as a patient pool and will be called as soon as possible considering clinic demand. If time permits, adults are notified by letter and/or phone for the availability of routine care and given a 15-day period to respond and schedule their appointment.

WALK IN CLINIC:

This clinic will care for acute emergencies on a daily basis [hours]. This clinic will also handle some treatment of routine patients.

Open Access

High risk groups of eligible beneficiaries including [insert current high risk groups such as Head Start children, children age 0-3, diabetes patients] will have Open Access to the dental clinic for preventive services including [insert services such as screening, fluoride varnish, OHI, exams]. Patients seen in Open Access will receive follow up care as needed according to the Patient Appointment procedures. Patients may report to Patient Registration before or after the Open Access visit.

Patient Appointments

To receive an appointment the patient must first become registered for care at the facility. Patients must meet eligibility requirements as determined by [facility] in order to schedule a routine appointment.

The registered patient will be given an appointment for [procedures that may be requested] when requested.

Patients with scheduled appointments will report to the dental clinic and sign the dental register. The dental receptionist will check the posted appointment schedule and notify the dental auxiliary that a patient is waiting. When a chair is available a dental auxiliary will seat the patient.

Patients reporting more than 15 minutes late for an appointment may have to be rescheduled. To avoid being charged with a broken appointment they may be given the option of waiting until all the other scheduled patients have had their planned treatment completed for that day. The dentist will then determine if enough time permits to provide some dental care for those patients who are waiting. If the patient decides to reschedule his/her appointment after coming in late he/she will be charged with a broken appointment. [This section should be based on a facility policy]

Scheduling Priorities

Describe priorities for dental appointments

Example

  1. Emergency dental needs (See Policy B.4)

  2. Severe Medically compromised (e.g.,pre-organ transplant, or pre-chemo/radiation therapy)

  3. Children

  4. Deploying military personnel

  5. Students (to accommodate school schedule/breaks)

  6. Adults

B.2 AFTER HOURS, EMERGENCY DENTAL CARE, and TRIAGE

PURPOSE


To establish criteria and procedures for emergency dental treatment during and after routine dental clinic hours.



PROCEDURE



Definition

A dental emergency may include but not be limited to one of the following:



  • Severe pain that started within the past 2 3 days

  • Severe pain that keeps the patient awake at night

  • Facial swelling

  • Fever due to an oral infection

  • Excessive bleeding following dental treatment

  • Teeth that have recently been loosened, knocked out or broken due to trauma

  • A facial injury with possible maxillary or mandibular fracture.


Intake Procedures

(Describe procedures followed for emergency patient intake and processing)

Example: Clinics with On Call Dentists

When emergency patients call or present for treatment, medical or dental staff may use the triage questions listed above to determine if the patient can wait to be seen in the dental clinic or should be immediately referred to the Emergency Room. Patients to be seen in the dental clinic will sign the dental register at the reception window. Emergency care referrals will be made to the dental clinic by the Ambulatory Care clinics. These referrals will be presented by the use of a referral form during regular working hours.

After regularly scheduled hours, verbal instructions will be taken by the dentist on call in order to assess patient needs. This dental provider will speak directly to the medical provider to ascertain the nature of the complaint. Appropriate transfer of the patient to dental referral services or delivery of dental care service will be determined by the dentist on call.

Example: Clinics without On Call Dentists

When emergency patients call or present for treatment, medical or dental staff may use the triage questions listed above to determine if the patient can wait to be seen in the dental clinic or should be immediately referred to the Emergency Room. Patients to be seen in the dental clinic will sign the dental register at the reception window. Emergency care referrals will be made to the dental clinic by the Ambulatory Care clinics. These referrals will be presented by the use of a referral form during regular working hours.

After regularly scheduled hours, patients should report to the Emergency Room for assessment and emergency care based on the Triage Protocols. Appropriate transfer of the patient to dental referral services or [Facility] dental clinic during routine clinic hours will be determined by the attending physician.

Scheduling

Emergency patients will be treated on a time available basis. Emergency patients will receive treatment the day they report to the clinic with their chief complaint, schedule permitting. The patient will be given medication for relief of pain and/or infection and rescheduled or referred if treatment cannot be rendered that day.

Emergency patients will be seen in the Dental Clinic [hours].

Patients with dental emergencies after normal clinic hours will report to [appropriate location].



Dental Triage Guide

Medical or dental staff may triage patients to determine dental emergency needs and necessary immediate interventions. If patients call with an oral health complaint, the following triage protocol is suggested.



Complaint

Suggested Therapy

Patient Disposition/Follow up

Severe pain that started within the past 2 3 days


Pain medication

Emergency Dental Clinic or next available scheduled appointment

Severe pain that keeps the patient awake at night


Pain medication

Emergency Dental Clinic or next available scheduled appointment

Facial swelling (mild), w/o fever, no airway restriction


Pain medication and antibiotics

Emergency Dental Clinic or next available scheduled appointment

Facial swelling(moderate-severe) w/ fever, no airway restriction


Pain medication and antibiotics

Emergency Dental Clinic (same day) or ER

Airway sequelae (e.g.,unable to open mouth, and/or can’t stick out tongue, and/or sublingual swelling, and/or uvula deviation


If Dentist available immediate dental evaluation. If no Dentist available, ER referral

Immediate dental or ER evaluation


Any airway restriction


Immediate evaluation and treatment

Immediate emergency care

Oral bleeding

If Dentist available immediate dental evaluation. If no Dentist available, ER referral

Immediate dental or ER evaluation and treatment

Trauma that leads to (e.g.,loose,

broken, or avulsed teeth, or where facial fractures are suspected)




If tooth knocked out, place tooth in milk (if possible) then ER referral for C spine/neurological clearance


ER. After cleared by a physician, have the patient follow up with the dental clinic

(Catawba Dental Clinic, Dr. Jeffrey Stuart, 2008)
B.3 ON CALL
(include this policy only if your facility has an active “On Call” program. For those clinics without an “On Call” program, See Policy B.2 “After Hours, Emergency Care, and Triage”)

PURPOSE:
To provide for consultative services in the event of dental emergencies at the [Facility] during the hours that the dental clinic is closed.


POLICY:
The Dental Program shall have one Dentist in “on call” status at all times. The “on call” dentist will be available by cell phone at all times for the purposes of providing verbal consultation in regards to dentally related matters to other [Facility] professional staff members.
PROCEDURES: (Describe Dental Call schedule and procedures)

Example:




  1. All dentists working within the [Facility] Dental Department are required to rotate pulling dental call for one week at a time. To ensure fairness, there will be a separate rotation for the 10 annual Federal Holidays. If a dentist has a conflict and cannot pull call for a week that they are scheduled to be on call, it is their responsibility to find another dentist to trade call weeks with. Such trades must be appropriately recorded on the call schedule and both dentists must agree to the trade.

  2. The Deputy Chief of the Dental Program will have the responsibility of preparing and updating the dental call schedule.

  3. Dental call will start at 8:00am on each Wednesday and end at 8:00am the following Wednesday.

  4. The dentist on call should be available at all times by cell phone. Given that travel within the region, including to and from available housing, will often take dentists through areas without cell phone coverage, it is essential that dentists on call check their cell phone messages on a frequent and recurring basis. Any messages from the [Facility] in regards to a dental emergency must be returned as soon as possible.

  5. Because the standard of care is often difficult or impossible to meet without a trained dental assistant and there are no dental assistants available after-hours, on call dentists are only available for phone consultation. The vast majority of general dental emergencies are easily treated with antibiotics and/or analgesics until the dental clinic opens the following day. Cases involving facial fractures or severe life threatening swellings or infections are beyond the scope of general dentists and should be referred directly to an oral surgeon.

  6. A dental emergency kit is kept in the Emergency Room for use by the ER staff. On each Wednesday, the new on call dentist is responsible for:

    1. Restocking the ER’s dental emergency kit.

    2. Advising the ER staff that they are on call and giving them the appropriate contact information the ER staff will need in order to contact them in a timely manner.
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