Everyone talks about time management, but few address it realistically. We have a set amount of time each day to see a certain number of patients, to care for them appropriately and generate the most revenue possible for the office. It is a daily challenge for hygienists.
In general, a recall/hygiene appointment for a healthy patient should include:
• Update and recording of the patient’s medical and dental history (5 min)
Total 69 minutes
In some practices, the appointment must also include the use of a Cari-Vue or other caries detection device and recording of findings (5-10 minutes), and it must be remembered that fluoride varnish is placed after the dentist’s exam so as not to obscure the hygienist’s view of the teeth. Consider how long the hygienist waits for the dentist to come to the treatment room.
Some offices also want the hygienist to use the treatment room computer to make the patient’s next appointment, generate a walk-out statement and generate an insurance claim form. All in a 40-50 minute appointment.
What actually happens is that some services just do not get done.
Many offices long ago discarded the blood pressure reading and recording as being too time consuming. The rationale that a patient sees his dentist more than his physician, therefore can benefit from a blood pressure evaluation, has not compelled many offices to adopt this practice. Whether this is a good thing or a bad thing, the fact is many are not performing this service.
While an update of the patient’s medical history is extremely important, when time is short, this may also fall by the wayside. Offices do not like to talk about this, but it happens. If the patient has had a health situation that requires pre-medication, the dentist will not know. A dangerous post-hygiene complication for the patient may occur.
Full mouth probing and recording is another procedure that may or may not be accomplished. If the patient is perceived as being “healthy”, it becomes easy to do a little “spot-check” here and there and call it good. This happens more frequently in offices without a voice-activated recording system or access to an assistant to help. Without probing information, a new diagnosis of periodontitis may be missed. Not good for the patient, or for office revenue.
Home care instructions may also be ignored when time is short. Patients already know what they should be doing, right? And if time is getting short during the appointment, a less than adequate scaling and polishing may happen. If the hygienist knows the next patient is waiting and the dentist must time for an exam, pressure builds to “finish up”.
If the hygienist must schedule the patient’s next appointment, generate a walk-out statement, and/or generate an insurance form, treatment time is also significantly shortened.
By these examples, it can be readily seen that few clinical hygiene services can be eliminated without a possible negative consequence. How can we manage our time more appropriately?
• Schedule longer hygiene appointments. Make each appointment at least one hour. Even at one hour, a hygienist must keep moving relentlessly.
• If appointment times are not lengthened, eliminate some services performed by the hygienist. The most obvious choices would be non-clinical services such as making a patient’s next appointment and generating statements and forms. Allow for the hygienist to accompany the patient to the front desk area where clinical staff handle these necessary tasks.
• Work to develop less waiting time for the dentist’s exam. Allow for the dentist to come in any time during the patient’s hygiene appointment, not just at the end. This one step alone can greatly streamline the hygiene day. The dentist watches the schedule, and comes in when he or she has an appropriate “break” in patient treatment time.
• Invest in voice-activated software for probing depth recording; or allow for an assistant to be available for short periods during the hygiene appointment. Identifying periodontal patients cannot be accurately documented without complete recording of conditions. In addition, insurance carriers will not cover periodontal procedures without appropriate verification.
It is very important to always consider the most essential elements of a hygiene appointment. Updating the patient’s medical history, probing and recording, appropriate radiographs, scaling and polishing and home care instructions fall into the “essential” category. Shortcuts in these areas are not in alignment with current dental practice. Additional important clinical services such as the use of decay detecting devices, blood pressure readings, photographs, and fluoride application need to be considered as well. Realistically considering what can be done during the time provided is important to be sure the most important services of the hygiene department are not neglected.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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