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 and the Kansas City metro area Emergency Departments exhibit similar data. The major concern with this care delivery model is that the majority of EDs do not have the ability to definitively treat these patients beyond basic pain and infection control.
With the assistance of the Mid-America Regional Council (MARC), an Oral Health Access Committee was formed to look at ways to improve oral health access for area residents. The hospital ED with the highest number of oral health pain visits based on ICD-9 non-traumatic diagnostic codes was chosen for the ED diversion project.
The main concern identified by patients who visited the ED for oral health pain was their inability to find follow-up care in a timely manner. The purpose of the pilot project was to provide a clinic site for patients to receive dental treatment within 24-48 hours for their pain and prevent repeat visits to the ED for the same condition. The ED can make an appointment in a dental clinic the following day for each patient. Four clinics were included in the pilot for patient referrals. Each clinic site determines the times and the number of slots that are held for the patients referred from the ED. The appointments are entered into the online calendar and each clinic accesses that website each morning to confirm the appointments.
The number of referrals made during the pilot period was 300 patients that were seen in the ED for non-traumatic dental pain. Kept appointment rates from the referrals to the dental clinics have been 28 percent.
The demographics show a 50/50 gender breakdown in visits. The age group with the highest number of visits was the 18-29 year olds (33 percent) followed by 50-59 year olds (24 percent). Race/ethnicity breakdown showed Blacks with the highest number of visits (54 percent) followed by White/Caucasian (31 percent).
The majority of procedures performed at the dental clinics was oral surgery (73 percent extractions). Return visits to the ED without treatment for their oral health pain was 12 percent. Satisfaction survey data has shown 100 percent satisfaction with the clinic and treatment along with the referral process.
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 EDs in the Kansas City metro area, additional dental clinics and possible private practice providers to improve access to care. Community health workers trained in oral health care may improve the percentage of patients who keep their appointments.