While it isn’t a simple task, practicing dental sedation—with hospital-grade care—in a local dental office environment is possible when the right measures are taken. To be able to provide hospital-grade care, dentists need to take into consideration the logistics for their team and patients, comfort for their patients and guardians, and above all, patient safety.
Clinicians have different thresholds for the environment in which they are willing to work; not everyone is comfortable working outside of a traditional surgical operating room (OR). However, with a team approach, strict screening protocols, and a safe physical space, it is possible to bring safe, hospital-grade care to nearly any environment, including a dental practice.
Patient selection and screening
There are certain patients who should be seen in the hospital, and there are those patients who are a better fit for in-office care. A diligent and efficient patient screening process to distinguish between the two is the most important part of operating a safe and successful mobile anesthesia practice.
In a mobile OR setting, the dental office staff prescreens patients by looking for medical issues that would require an appointment in a hospital OR, such as extensive cardiopulmonary sequelae or morbid obesity. After this initial vetting, the patient information undergoes a second review. The anesthesiologist is involved in reviewing these cases and communicating with patients as well.
Once all parties verify that a patient is an appropriate candidate for in-office care, the dental office reaches out to schedule the procedure. Even after the extensive screening process, the mobile anesthesia team works with the dentist(s) to contact patients in the week and day before their appointments to verify current health, medications, and reiterate perioperative instructions.
These final verifications and instructions are great benefits of operating in-house. Patients and their guardians know who to call with questions, they aren’t being sent around a hospital to contact multiple departments, and they can take advantage of the flexibility that occurs with a practice working independently of a busy hospital OR. As simple as it sounds, these benefits will create a much more pleasant experience overall for patients.
Creating a “hospital-grade” setting
In hospitals, the team usually consists of a circulating nurse, a surgeon, an anesthesia provider, and postanesthesia care unit (PACU) nurses. When working in a mobile operation setting, in addition to an anesthesiologist, the team consists of a paramedic, a PACU nurse, and a dentist. The benefit of a team model, as opposed to the operator-anesthesia model, is that the mobile team can facilitate more efficient and safer patient care.
Working within a team is especially important should an urgent situation arise. Having a team to depend on allows the anesthesiologist not only to know individual members but their levels and abilities in crises, which allows the team to work more efficiently in urgent cases.
Also similar to how a hospital might approach setup, mobile anesthesiologists focus on three separate physical spaces: one for preoperative assessment, the “operating room” setup, and a PACU. Essentially, the only thing that differs between the mobile setup and a hospital arrangement is the physical proximity between the spaces. Mobile ORs have a considerable advantage in this area. In a hospital, the pre-op room is often much farther away from the operating room, and the same goes for the recovery area. In a dental office, everything is close by; patients aren’t being led down winding corridors with their guardians left behind in a faraway waiting room. A mobile OR eliminates what can be an intimidating experience for pediatric patients in particular.
The same goes for being able to perform the procedure in a dental chair (a familiar place for the patient), rather than a daunting operating room. For both children and adults, this familiarity helps with acceptance and reduces overall anxiety. Similar to the physical setup, mobile ORs are also intentional about equipping themselves with sets of medications identical to that found in a hospital. If an emergency occurs, this can be a crucial advantage. Overall, in terms of the process and environment, mobile anesthesiologists work to emulate the best of the hospital OR but in a more familiar and convenient environment—the dental office.
Why go mobile?
When patients can stay in a familiar setting—where they know the receptionist, know how the parking works, and they don’t have to navigate a confusing hospital campus—anxiety is reduced, which translates into a more positive experience. Mobile procedures also provide an economical advantage to patients. For instance, SmileMD, a mobile anesthesia services company, has found that procedures using mobile anesthesia in-house are around one-tenth the cost of the same procedure in a hospital.1 And after the pause in elective surgeries that many hospitals found themselves facing during the COVID-19 pandemic, backlogs in ORs have created increasingly long wait times.
With in-office care, reductions are seen in driving times, gas costs, potential hotel stays, and time off required from work—all expenses that would likely be incurred during a hospital visit. If you take the right steps and work with a provider who can set up your mobile operation for success, you will be able to provide hospital-grade care right in your dental office.
Reference
- Accessible anesthesia. Anywhere. SmileMD. https://www.smilemdsedation.com/
Spencer Wade, DDS, received his bachelor of science from the University of Michigan in 2012 and his DDS from the Ohio State University in 2016. Immediately following, he conducted his dental anesthesiology residency with the Ohio State University Wexner Medical Center. Dr. Wade practices dentistry in Dublin, Ohio, and has been working with SmileMD since 2019. SmileMD, a mobile anesthesia services company founded by anesthesiologists, works with dental anesthesiologists and MDs to provide anesthesia to pediatric and adult dental patients at in-office settings, increasing access to care for thousands of patients each year.
