5.7.10 Issue #426 Forward This Newsletter To A Colleague

Carol Tekavec, RDH
Hygiene Consultant
Printer Friendly Version

Hygiene Scheduling - Never Enough Time?

Hygienists may complain about lack of time to complete necessary hygiene services.  Dentists may complain that the hygienist has enough time, but just doesn’t get the appropriate tasks completed.  So… what is “enough time?”

Dental offices commonly allow 40-60 minutes for a typical prophy and recall. (While there are other names given to this appointment, such as “recare,” we will call it by the name many of us know and use: “recall.”) But are 40-60 minutes enough time? What procedures are expected to be performed during the appointment?  Does the hygienist provide all services by herself?  Is there time allowed for set-up and clean-up? Does the hygienist take blood pressures?  Radiographs?  Provide fluoride treatments? Oral hygiene instructions?  Intraoral photos?  Identification of possible future restorative needs to support appropriate patient care and office production?  

What about entering information into the computer? Does the hygienist enter updates to the medical history, probings and other perio considerations, findings of the dentist’s exam, and progress notes? Does she also go over future treatment plans, print out an estimate of fees for those plans, set up future appointments and generate a “walk-out” statement of fees for today’s services? It can readily be seen that a “typical prophy and recall” may encompass much more than the just the actual clinical service. Let’s look at a possible break down of time required.

  • 5 minutes: Seat patient and update medical history
  • 3 minutes: Take and record blood pressure
  • 10 minutes: Take 4 BWS, expose and develop or generate digitally
  • 15-25 minutes: Take FM series (every office needs a “radiographic protocol” which should be set up by the dentist for all staff to follow)
  • 10 minutes: Alternately - take panograph (depending on office “radiographic protocol”)
  • 1 minute: Do extra/oral head/neck cancer screening
  • 1 minute: Do intra/oral cancer screening
  • 5 minutes: General oral screening. This may include evaluating current restorations, visible decay, broken teeth, tissue issues, painful teeth, calculus, evidence of plaque, and problems mentioned by the patient
  • 5 minutes: Take intra/oral photos of restorative concerns to have ready for the dentist
  • 10-20 minutes: Perio probing, including data collection and documentation of 6 measurements for each tooth and recording of bleeding, mobility, furcations and recession.   
  • 20-30 minutes: Prophy procedure-scaling and selective polish (patients who require more extensive scaling or other treatments should be identified).
  • 1 minute: Oral hygiene instructions
  • 5-10 minutes: Dentist’s exam - have photos and radiographs ready to view, concerns from oral screening ready to discuss
  • 5 minutes: Fluoride application - varnish or tray
  • 3 minutes: Enter progress notes
  • 2 minutes: Enter next appointment
  • 3 minutes: Assist patient in filling out recall reminder
  • 5-15 minutes: Explain, enter, and print out  a treatment plan for necessary treatment identified during appointment
  • 3 minutes: Enter and print a “walk-out” form with fees for the day
  • 5-7 minutes: Return to treatment room - clean, take instruments to sterilization, set-up for next patient

Total time for the least time consuming options = 102 minutes! Even if you take off the FM series or panograph and/or the fluoride application, you still have around 80 minutes.

Does this mean that in order to perform all duties expected, the hygienist needs at least an hour and twenty minutes? The answer is “yes” if all of the services listed are performed by the hygienist alone. The answer is “no” if some of the services are excluded, an assistant is available to help, technology is employed to save time, or others perform a portion of the tasks. The hygiene department is an important production generator for the office. If necessary dentistry is not identified at a patient’s recall appointment, when will it be identified? If an office is committed to pursuing an appropriate periodontal evaluation, assessment of needed restorative work, and explaining and implementing a treatment program for patients, when will this be accomplished if not at recall?

One answer to the time problem might be to find a method of delegating to other staff members parts of the “prophy/recall” not required to be performed by a licensed hygienist.  While all staff members are busy, there are some segments of the aforementioned list that might be appropriately performed by others, or with the assistance of others, without causing a disruption in daily activities. The use of technology can also help. In addition, some services might be performed once annually instead of at each appointment.

Some ideas:

  • Business staff can be in charge of entering the patient’s next appointment, generating a “walk-out” form after the hygienist has entered the patient’s treatment and fees for the day, further explaining needed treatment, generating a printed treatment plan for the patient, and overseeing the completion of the recall card reminder after the hygienist has filled out individual concerns. Time savings: 8-20 minutes.
  • An assistant can be made available for recording probing depths, either on a paper or computerized format. Alternately, technology can play a role. A voice activated computer system or automated periodontal probe can reduce time while still allowing for complete data collection. Time savings: 5-15 minutes.
  • If the hygienist is running late, necessary radiographs might be taken by an assistant in another treatment room prior to the hygienist seating the patient. Time savings: 5-20 minutes.
  • Some services might be done once annually, such as taking and recording blood pressure, instead of at each prophy/recall. This would not be appropriate if the patient has given information indicating new concerns, has a current blood pressure problem, or has had a change in general health. Time savings: 3 minutes.

At your next staff meeting, brainstorm what might be done to streamline the hygiene schedule in your own office. The dentist and the hygiene department are production centers, and it benefits everyone in the office if revenue is being consistently generated at these centers. No revenue is generated if hygienists are using time to perform duties that do not have to be performed by licensed personnel. Despite this, not all offices will agree on what should or could be delegated, and state laws may mandate who performs certain procedures. As always, the appropriate treatment of patients is the most vital concern. It is important to patients, all team members, and the financial health of the practice to see that patients have their needs identified, scheduled and treated. Taking a close look at hygiene scheduling can be a significant part of making sure that this happens.

Carol Tekavec CDA RDH is a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

 Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

Forward this article to a friend.

McKenzie Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to: webmaster@mckenziemgmt.com
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to: info@mckenziemgmt.com
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at: sallymck@mckenziemgmt.com
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.