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It's so Easy: Treating emergency patients

Jan. 1, 2001
In the last issue, I focused on the importance of organization in the dental office, particularly in the clinical area.
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In the last issue, I focused on the importance of organization in the dental office, particularly in the clinical area. OK, so now we're organized. What are the benefits? Organization means less stress, resulting in days filled with joy and pleasure. You actually look forward to the workday!

But what happens when you are well prepared with a perfect schedule in place and the emergency patient calls?

Every practice-management guru has his or her own special way for handling emergency patients. As a result, many different solutions have sprung up in dental offices. One popular system is to leave open time in the schedule, every day, usually a half-hour in the morning and a half-hour in the afternoon. (If you are having this many emergencies, it may be a symptom of other problems in the practice.)

What happens if the patient can't or won't come in at that allotted time? What becomes of the un-scheduled time if you don't have any emergencies? You just lost an hour of productive time! Then there are times when the doctor does more than what is necessary to assure that the patient will be comfortable. This generally leads to problems like working through the lunch hour or overtime in the evening, often upsetting the morale of the team. This way of treating emergency patients simply did not work for us - especially when we tried to schedule every day as "perfect day."

Organization is the only solution. The doctor and team must decide how they want to handle emergency patients in the practice. Then they must set up a system and implement that system. The system starts when the patient calls with an emergency. Everyone in the office must know the procedure that occurs when the patient calls.

In our office, we decided that the most important thing to accomplish was to eliminate pain. So our goal was to treat the patients so that they were comfortable by the time they left the office. When we see an emergency patient, we only do palliative treatment. We address the immediate problem and then reschedule the patient for further treatment. This also gives you the opportunity to do comprehensive examinations and to present complete treatment plans.

The first question that we ask of emergency patients is, "How soon can you be here?" Their answer will tell you many things. If they can't arrive until 4 p.m. a week from Tuesday, then they have just informed you that it's not a true emergency, and you can prescribe some medication to take care of the problem.

We don't leave any open time in our schedule for emergencies. Our receptionist tells them to come in right away. She tells them that we are working them into our busy schedule and that we will see them as soon as we have a dental chair available. This alerts them that they may have to wait. The receptionist then assures these patients that we will make them comfortable before they leave the office. She then alerts everyone in our office that an emergency patient is on the way.

Everyone on the team (including the business office personnel) is well trained in treating an emergency patient. Most emergencies are not "rocket science," and simple observations often determine what the problem is. Frequently, the patient will tell you what the problem is. In medicine, this is called triage. It is a simple matter to gather the necessary information (X-rays, photo, percussion test) needed to confirm your observations. So, if Dr. Blaes and I are involved in a three-hour procedure, anyone else in the office can get the emergency patient back to an open treatment room immediately and start the process. That staff member will gather as much information as possible about the problem, whether that means taking an X-ray, using the intraoral camera, updating a health history, or simply holding the patient's hand.

The information is presented to Dr. Blaes in the treatment room, and a treatment decision is made. At this point, Dr. Blaes will interrupt his treatment to confirm a diagnosis with the emergency patient and talk to the patient about treatment that will be done that day. Anesthetic is given at this point, and Dr. Blaes returns to his procedure.

In our office, endodontic procedures are referred to a specialist who has agreed to see our emergencies. So off they go with their X-ray or the X-rays are electronically sent to the specialist immediately. If you live in a small town where there is no endodontist, then the tooth must be opened and palliatively treated. This can be done rather quickly if you are organized and you have a preset tub for emergency situations.

What about the broken cusp or the fractured tooth? Well, that old composite that is in the bottom drawer works great as a nice temporary filling until the patient is rescheduled for a crown/bridge treatment. Since the tooth is usually rough, you will not need to use etch or bond to hold the temporary in place.

Every single emergency that you will see can be easily treated, if you are well organized and prepared for the situation. Many times, the doctor does not even need to see the patient. This system will work flawlessly every time.

Not all emergencies are simple, but they can be handled quickly and easily if you have organized the clinical area.

Here's how we treated a more difficult case. Ruth called at 3:30 p.m. to report that a crown came off. She was concerned because she was giving a speech the next morning to the Rotary Club.

Missy asked, "How soon can you be here?" Ruth arrived at the office 20 minutes later and handed Missy her crown.

I took Ruth back to the treatment room and quickly determined that we could not recement the crown, since the root was split and there was a periapical lesion on the tooth. If this post crown had been recemented, she probably would not have even made it out of the parking lot before it fell out again.

This case required additional treatment to make the patient comfortable. The remaining root tip had to be extracted and something put in its place so Ruth could smile and feel confident during her presentation the next morning. We explained to Ruth that the tooth had to be removed and then replaced with a fixed bridge and that she would leave with a temporary bridge in place.

We put the post crown back and then took an impression so a temporary bridge could be made. Dr. Blaes feels that it is the general dentist's responsibility to prepare the extraction site to assure that there will be an esthetic pontic site when the extraction area has healed. Many times, a specialist will remove the labial plate of bone and the area heals with a cleft that is unacceptable as a pontic site. Dr. Blaes slipped the root tip out, placed some hydroxyapatite (synthetic bone), and sutured everything in place. The abutment teeth were quickly prepped for crowns, but no impressions were made. The final preps and impressions will be done after the area has healed and the bone has filled in. The last step was to make Ruth a nice three-unit temporary bridge.

Ruth no longer had to worry about losing her crown during her speech. We explained to her about the need for the extraction and replacing it with a new bridge. She was then scheduled for a postoperative appointment the following week. The entire procedure took less than 30 minutes from the time Ruth was seated. Our organization allowed for everything that we needed to be ready for Dr. Blaes. For this particular procedure, we charged for the extraction, rebuilding the pontic site with hydroxyapatite (synthetic bone), and for the provisional.

When we do simple palliative treatment, we do not charge for emergency visits even for new patients. However, we do charge for "significant" emergency treatment, as in Ruth's case. This tells them that we truly care about their well-being, and they will always reschedule for a new-patient visit - frequently referring other patients to us as well.

We truly give our emergency patients the "red carpet service." We treat them as we would want to be treated. We follow up with our patients that we referred out of the office, ensuring their problem was addressed to their satisfaction. We also answer any questions that they may have about additional treatment.

So, take a look at how you treat emergency patients. If they routinely upset your day or if you are always running behind schedule, put the systems in place to have a "perfect day" every day! You'll be glad you did!