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Dental Public Health Activities: Descriptive Summaries

Emergency Department Diversion Project

Practice Number: 28008
Submitted By: University of Missouri Kansas City Dental School
Submission Date: September 2015
Last Reviewed: September 2015
Last Updated: September 2015
Best Practice Approach Example Emergency Department Diversion Project
 

Background:

The national trend for patients who have dental pain and lack a primary care dentist is to access Emergency Departments (ED) for treatment for their oral health issue. Missouri data (ref*) follows these same trends and a study done in the Kansas City metro area of Jackson County MO Emergency Departments found similar data (ref*). The major concern with this model is that the majority of EDs do not have the ability to treat these patients beyond pain and infection control.

Methods:

With the assistance of the local program MARC (Mid-America Regional Council), an Oral Health Access Committee was formed to look at ways to improve oral health access for area residence. The urgency of Emergency Department visitation for oral pain was significant, so the committee chose to conduct a pilot project to address this issue. The hospital ED with the highest number of oral health pain visits based on ICD-9 codes was chosen to start the ED diversion project. The main concern identified by patients who visited the ED for oral health pain was their inability to find a dentist or dental clinic to receive follow-up care in a timely manner.

The purpose of the pilot project was to provide a clinic site for patients to receive treatment with-in 24-48 hours for their pain and prevent repeat visits to the ED for the same condition. A program was set-up that allows the ED to make a reservation in a dental clinic the following day. The 4 initial clinics included UMKC School of Dentistry, Sam Rodgers Health Center, Cabot Westside Clinic and Seton Center. Each clinic site determines what times and the number of slots that they will hold for the patients referred from the ED. The patient’s first and last initials are entered into the online appointment calendar and each clinic will then access that web site each morning to confirm the appointments.

Results:

The number of referrals made during the 3 (maybe 4) month pilot period was 300 patients seen in the ED. Show rates from the referrals to the dental clinics were 28% (low to high %).  The demographics show close to a 50/50 gender breakdown in visits. The age group with the highest number of visits was the 18-29 year olds (33%) followed by 50-59 year olds (24%). Race/Ethnicity breakdown showed Blacks with the highest number of visits (54%) followed by White/Caucasian (31%). The majority of procedures performed at the dental clinics were oral surgery (73% extractions).

Conclusion:

A total of 300 patients were given an appointment from the ED for treatment of their oral health pain that could not be treated in the ED. Due to no-show rates, capacity still exists for patients to be seen and treated. Future plans are to expand the number of ED’s in the Kansas City metro area, additional dental clinics and possible private practice providers to improve access to care.

The online referral program is an Excel data base format this is password protected between the ED and the participating dental clinics. The program is called Sign Up Genius and was purchased by TMC Emergency Department for approximately $100. A MARC staff personal maintains the data base monthly as part of their commitment to the community. Thus cost of this program is minimal except for the Sign Up Genius online program and personal time.

Lessons Learned:

The online program used for this pilot program is not the ideal program to use for this activity. A better solution would be to use a HIPPA compliant program. This would allow the ED to place patient specific information into the secure data base for better communication to the dental clinics. Options are being explored at this time for a program of this type but no specific program has been identified at this time.

Contact Person(s) for Inquiries:

Dr. Michael McCunniff, University of Missouri Kansas City School of Dentistry, 650 East 25th Street Kansas City, MO, 64108, Telephone: 816-235-2185, Email: mccunniffm@umkc.edu

Dr. Mike Jurkovich, University of Missouri Kansas City School of Dentistry, 650 East 25th Street, Kansas City, MO, 64108, Telephone: 816-235-2161, Email: jurkovichm@umkc.edu

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