When COVID-19 shut down much of our economy, many dental practices took a hit, despite being named essential businesses that could remain open. Appointments slowed because of capacity limitations, patient cancellations, and fewer new patient enrollments. We didn’t know how individual dental practices would be affected in the short term or how patients would receive the care they needed.
But we could anticipate that there would be a return and that we had better be prepared for it. One day soon, we thought, the office phones would start ringing and the schedule would fill up. We would have to figure out how to serve patients and, in some cases, prioritize care based on need and urgency.
SmileMD, a startup that delivers mobile anesthesia care teams, experienced the pandemic in lockstep with dentists and clinicians. After the shutdown, we saw a surge in need as more patients preferred to undergo treatment in their local dental office instead of traveling to a hospital operating room (OR) that, in many cases, was in another county.
Not only that, but OR backlogs were growing. Since hospital ORs had large backlogs for services, many dental and oral procedures were waitlisted for several months. Luckily, telehealth was a game-changer for a lot of healthcare providers, but it couldn’t solve everything.
As practices were once again allowed to provide treatment beyond urgent and emergency care, dentists came to face this new reality and needed to move fast, both to develop a plan for reopening under new cleaning and scheduling regulations and to actually get through their backlog of surgical procedures. For those who wanted to keep their patients out of the OR, there was a lot to keep in mind.
When managed correctly, using a mobile anesthesia provider to provide dental surgery in your own office instead of referring patients to an OR can be extremely effective for working through a backlog safely and efficiently. In fact, when discussing this route, the American Academy of Pediatric Dentistry (AAPD) cites studies that support its safety and cost-efficiency.
Finding the Right Partner
Above all else, patient safety is the number one priority. Choosing to engage with an anesthesia provider is a big decision for any practice, and it shouldn’t be taken lightly. The AAPD has provided a thorough list of questions that an office should discuss with any potential provider. These questions cover topics such as experience with pediatric and other specialized patients, equipment and monitoring protocols, contingency plans in case of emergency, auditing, maintenance of equipment records, and record-keeping.
Identify Your General Anesthesia Candidates
Along with selecting a partner that fits your office’s needs, it’s also important to determine which patients on your schedule are the best fit for in-office procedures. There are four patient categories that will most benefit from in-office procedures: pediatric patients, patients with developmental disabilities, patients with general anxiety concerns, and complex cases that require multiple appointments.
Pediatric patients almost always require general anesthesia for any invasive procedure, so keeping the procedure at their familiar dental office and out of a hospital can help quell any additional fears. Similarly, we find that patients with developmental disabilities as well as patients with general anxiety concerns also benefit from being able to receive general anesthesia in a familiar, smaller office setting.
And for reasons of practicality, complex cases that require multiple appointments at an OR could either benefit from in-office scheduling that allows for multiple procedures in one visit and reduces the travel time of having to drive to a hospital that’s farther away multiple times.
After assessing your patients in these four categories, you’ll want to review your patients’ health histories with a trained anesthesiologist to determine whether a patient could be seen in an office setting. If for any reason you feel that a patient is at risk for complications when undergoing general anesthesia, they should remain in line for the OR where they can receive immediate emergency care if needed. Those patients should quickly be referred to the nearest capable hospital.
Assess Your Office Space
New COVID-19 rules around social distancing already have us reassessing the physical space we have to work with, which makes determining how your office can support in-office procedures even more crucial. Ideally, two separate operatory rooms are needed, one for the procedures and one for patient recovery. As you set up these spaces, also keep in mind that staff will be needed to manage and sanitize these rooms.
For specifics on how to clean, arrange, or set up these rooms, reference the most updated guidelines from the Centers for Disease Control and Prevention about surface sanitization and social distancing, and make sure your entire staff is comfortable with your setup.
In addition, make sure your office has the proper emergency equipment such as automated external difibrillators and malignant hyperthermia kits or that your anesthesia provider choice brings everything you need to deliver a safe experience.
Schedule and Prep
Once you’ve taken care of your office space and your partners and you’ve selected which patients will benefit from in-office procedures, it’s time to start scheduling. Set your case days for the coming months to establish the framework, and then contact patients in the order that you find appropriate, whether it’s chronologically by whose procedure has been delayed the longest or whose progression of disease poses the largest risk.
When scheduling, ensure that you are following AAPD guidelines, which suggest staffing every procedure with a team of three people, including two who are Pediatric Advanced Life Support certified. As you contact each patient, work with your anesthesiologist to provide all the necessary information about pre-op instructions, billing, consent, and discharge.
Going Forward
Taking on a new responsibility, such as performing in-office procedures after routinely outsourcing them to an OR, can feel daunting. But the right partner can help, and taking the leap will cut down on your patient backlog and reduce the chances of disease progression as well as improve your relationship with your patients, allowing them to visit a familiar office instead of an OR where they are just a timeslot and a profit. Lastly, this can help keep your office in business by bringing in much needed revenue after the stress of the COVID-19 shutdowns.
Mr. Agrawal is the CEO of SmileMD, a venture-backed startup based in Columbus, Ohio, that brings anesthesia services to dental offices throughout the country, increasing patient access to care while enhancing safety and efficiency within in-office operating rooms.
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