By Dr. Donald A. Crumb
It’s 7 a.m. on a workday. The staff and doctor are gathered for their morning huddle to discuss the clinical schedule for the day. Just as the meeting is about to begin, the doctor notices two emergency patients have been fit “in between” patients into his already congested schedule. One patient, Mrs. Jones, is scheduled for a broken tooth, and the other, Mr. Davis, is scheduled for a toothache. Before anyone has a chance to say anything, the doctor’s discussion with the appointment coordinator goes something like this ...
Doctor: “Why did you put Mrs. Jones in at that time? Is she in pain? Is a front tooth broken?”
Appt. coordinator: “She wanted to be seen today and there was no time available in your schedule. She didn’t tell me what tooth it was or if it hurts.”
Doctor: “She doesn’t expect me to fix that today, does she?”
Appt. coordinator: “I don’t know.”
Doctor: “What about Mr. Davis?”
Appt. coordinator: “He’s been in pain for a while and he’s going out of town for an important business trip tonight. He doesn’t want to have a problem when he’s flying or while he’s at his meeting.”
Doctor: “Maybe we can do a quick repair on Mrs. Jones. I’m not sure. I hope it isn’t No. 8. We have advised her before that that tooth will need a crown if it fractures.”
At this point the doctor is obviously in a bad mood.
Doctor continues: “Call Mr. Davis back and tell him to come in during our lunch hour.”
Doctor’s assistant: “I have an appointment at noon that I can’t miss.”
Doctor: “Whatever! Let’s get to work!”
So much for the business scheduled to be discussed at this meeting. There was little time left and no one was in the mood. After the doctor leaves the room, the appointment coordinator is almost in tears. She says to her coworkers, “Doesn’t the doctor know that when these patients called the office yesterday things were very hectic in the front office? Does he think that I went to dental school? How am I supposed to know what’s wrong with Mr. Davis’ tooth or how much time the doctor will need to treat him?”
The doctor is disappointed that nothing positive was accomplished at the morning meeting. He wonders why the front office staff never seems to have the answers to what he considers obvious clinical questions. How can the doctor be expected to effectively manage his time if he has no idea what the patient’s problems or expectations are?
Although this example might be a worst-case scenario, we can agree that this is not an ideal way to start the day. What is the solution?
A critical component in the management of dental emergencies is the triage process that precedes clinical treatment. The word triage is derived from the French word trier, meaning to separate, sort, or select. Most of us are familiar with the triage process that takes place in hospital emergency rooms. Basically, it’s a process of determining the priority of patients’ treatments based on the severity of their condition. Put another way, triage is the initial assessment of a situation to determine the patient’s need and which course of action to follow.
The triage process in a dental office begins when a patient calls with a dental emergency. The more information that the front office staff gathers during the initial conversation with the patient, the more efficient the patient’s treatment will be. The goal should be to learn and record adequate information so that the appointment coordinator knows where best to schedule the patient, and the dentist and clinical staff know what to expect when the patient arrives. Information needed includes:
1. The nature of the patient’s dental problem
- Does the problem involve a tooth? Where is it located? Is the tooth fractured? What is the extent of the fracture? Does the problem involve the tissue around the tooth? Is there any bleeding?
- Is it a problem with a denture? If so, is it broken, loose, or causing a sore spot?
- Does the problem involve a crown or bridge? Is it loose? Is the porcelain fractured? What is the extent of the fracture?
- Did the patient experience some trauma? What is the extent of the trauma?
2. Is the patient in pain?
- When did the pain start? Is it getting better, staying the same, or getting worse? What is the intensity of the pain? (1 to 10 scale) Is the pain spontaneous? What is causing the pain? (hot, cold, sweets, biting pressure) Does the pain go away right away or does it linger? What, if any, medication is the patient taking to relieve the pain?
3. Is there any swelling? What is the extent?
4. Is it a cosmetic problem?
5. Does the patient require premedication prior to dental treatment?
6. What is the patient’s dental history in the problem area? (review chart)
Expecting a front office person to be proficient at initiating the triage process without adequate training is unreasonable. Doctors think to ask these questions and understand why this information is necessary because that’s how they were trained, and they experience patients’ symptoms and problems on a daily basis.
Let’s assume that the scheduling coordinator triaged Mrs. Jones and Mr. Davis during their emergency telephone calls. The morning huddle meeting might have gone more like this:
Appointment coordinator: “Doctor, there are two emergency patients in your schedule today. Mrs. Jones had a small piece of tooth fracture yesterday on her lower right molar area. She says it is the second tooth from the back and she doesn’t have a third molar so I believe it is tooth No. 30. That tooth has a 15-year-old MOD amalgam restoration. She doesn’t have any pain but it is sharp to her tongue. I advised her that you would be able to smooth the sharp spot for her and that you would discuss the best way to permanently restore that tooth.
“I believe that Mr. Davis might need a root canal started. He is having sharp, throbbing pain (about 8 on a 1 to 10 scale) spontaneously that increases whenever he drinks hot liquids. There is no swelling at this time but the pain is worsening. I advised Mr. Davis that you would have your second assistant take an X-ray and then you would do a clinical exam to determine the cause of his pain and what treatment is needed. He knows that if a root canal is needed that he will be referred to a specialist today. That’s why he is in your schedule first thing this morning.”
Doctor: “Great work! Let’s review the needs of the scheduled patients.”
When patients call the office with a dental emergency, they deserve to be reassured by a knowledgeable staff person who has some basic understanding of their dental problem. Patients can lose confidence in an office if their emergency is not handled in a professional manner. Their conversation with the front office staff can be perceived as a reflection of the level of competence that they will experience throughout the dental office. Successfully treated emergency patients are very appreciative and often become great referral sources.
Yes, triage is a front office responsibility.
Since 1976, Dr. Donald A. Crumb has practiced quality dentistry for patients in and around Syracuse. In recognition of his many accomplishments in dentistry, Dr. Crumb has been elected to the prestigious International College of Dentists. Trust, integrity, compassion and professionalism are the cornerstones upon which Dr. Crumb’s extensive dental experience have been founded. To contact him, visit www.crumbscranium.com.