3.5.10 Issue #417 Forward This Newsletter To A Colleague


Belle DuCharme CDPMA
Instructor/Consultant
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Scheduling Special Needs and Emergency Patients

In calculating procedure times and mapping out scheduling to meet the practice goals, thought must be given to time management of the special needs and emergency patients. Obviously, it is difficult to plan for the emergency patient but demographics and practice philosophy can dictate the frequency of this patient. Some dentists will see only one or two emergency patients a day and others will see anyone that calls. Affluent neighborhoods on the average see fewer emergency patients than poor or poverty level neighborhoods because the affluent are more apt to seek regular routine care. If you run the practice analysis by code report and note how many D0140 or limited oral evaluations you have for the last year it will give you a prospective of what you will probably get this year. This code should be used to distinguish the emergency patient from the new patient comprehensive D0150.

In the initial interview of the new patient, their health history will give clues to their specific needs. Special needs would include those patients with dental phobias, bleeding disorders, physical or mental handicaps, heart conditions, the elderly in wheelchairs or with limited mobility of limbs, neck and torso, and patients requiring premedication to prevent endocarditis or for management of anxiety. Having the right comfort tools available in the set-up will save time at the chair, for instance, a blanket for the elderly and a neck pillow for the patient with neck problems or nitrous oxide for anxiety. Patients having special needs usually require additional units of time on the schedule. How much time should be added to the patient’s time block must be communicated to the Scheduling Coordinator, otherwise they may be assigned the standard time to do the procedure when making appointments.

Elderly patients, homemakers, and retired patients who are available during daytime hours should be scheduled to fill times usually between 10:00am and 2:00pm. Young children should be scheduled for morning appointments as they are generally more cooperative after a full night of sleep and breakfast. Diabetic patients should be scheduled early in the morning when their insulin levels tend to be more stable. Patients covered under the Americans with Disabilities Act may also have special needs and it is wise to be familiar with this information.

If not managed correctly, emergency patients can wreak havoc on an otherwise well planned schedule. During the morning meeting it is decided by the clinical staff or the dentist where it would be advantageous to place an emergency patient should one or more call that day. Do not allow the emergency patient to dictate when they will come in that day. Having a planned time unit and codes for this patient helps to manage time and keep the practice on schedule. The emergency visit could include a limited oral evaluation, a periapical x-ray or two and a palliative treatment. Quoting the fee for these services and asking the patient if they are prepared to pay is good practice management as emergency visits are the most common unpaid visit seen on overdue accounts receivable reports.

Screening the emergency patient would include the following questions:

  • After asking for the patient’s name, ask: “Are you a patient of record with our practice?”
  • Ask: “Are you having discomfort? Please describe the discomfort or the nature of the emergency.”
  • Ask: “How long have you had the pain/swelling?”( as described by the caller)
  • Ask: “Is the discomfort constant?  Does is wake you up or prevent sleep?”
  • Ask: “Does the pain increase when exposed to heat, cold, sweets or pressure?”
  • Ask: “Are you under the care of a physician for a medical condition?”
  • Ask: “Are you taking any medications and do you have any drug allergies?”
  • Tell the patient: “The emergency visit today will be between $85 and $125.  We accept cash, Visa or MasterCard. Will that be a problem for you today?”

Emergency patients are in crisis and must be handled with kindness and care. It is important to educate the patient on establishing regular routine care to prevent future emergency visits. Connecting and building rapport with this patient can make a difference in their future quality of life. 

Want to learn more about managing your schedule and communicating with your patients?  Come join us for advanced learning and take the Front Office Advanced Training at McKenzie Management. 

If you would like more information on McKenzie Management’s Advanced Training Programs  to improve the performance of your team, email training@mckenziemgmt.com

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