The Q Appointment System: When The Next Appointment is Three Months Away'

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The Q- Appointment System When The Next
Appointment is Three Months Away.

• Dr. James B. Quartey
• Dental Director
• Gonzales Community Dental Center
• 228 St. George Street
• Gonzales, Texas 78629

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Objectives

• To design an appointment system that takes
  medical and other special needs into
  consideration when making appointments.
• Participants will be able to describe the Q
  appointment system.
• Participants will be able to identify the
  advantages and disadvantages of the Q
  appointment system.
• Participants will be able to design and utilize
  the Q appointment system in their practices.

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Q Appointments Q is for Quality

• It is not uncommon for the next available
  appointment to be three to six months away at
  community and migrant health centers. This
  creates a problem for the conscientious dentist
  or hygienist who knows the optimal treatment for
  a particular patient will be to see that patient
  within a month or less. The present appointment
  system at most community health centers (CHC) is
  determined by administration (i.e., the
  receptionist gives appointments on a first come
  first serve basis). Whereas administrative
  appointment system works well in private
  practice and at CHCs where appointments are
  available within a month, they do not serve the
  patient or the provider well when the next
  available appointment is routinely a month or
  more away. The Q appointment system is an
  attempt to correct this problem by reserving one
  day per week or one week per month, to be filled
  by the provider based on their patients special
  needs.

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SPECIAL NEEDS

• Cancer Patients
• Other Major Surgery Candidates
• Root Canal early is better
• Pregnant Women oral health pre-term
• Rampant Caries or Caries in 3-4 Q
• Abscessed Tooth Antibiotic Resistance
• Others (insurance? Travel? Wedding?...)

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Standards or Expectation?

• The optimum waiting period between appointments
  or to get a new patient appointment would be less
  than 6-8 weeks.  Emergency patients should be see
  within 24 hours.
• Dr. Jay R. Anderson, Chief Dental Officer,
  Clinical Quality Improvement Branch, BPHC, HRSA

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• Practically speaking, not every patient can get
  a permanent restoration the day of the RCT.  I
  recommend to patients to get a permanent
  restoration ASAP, but I feel somewhat comfortable
  if they have to wait a month.  
• Dr. Ken Tilashalski, Professor, Department of
  Diagnostic Sciences, School of Dentistry,
  University of Alabama at Birmingham

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• The last day of the week or the last week of
  every month will be reserved for specific
  appointments authorized by the dentist. This is
  to allow the dentist to bring back those patients
  that had been seen earlier in the month and need
  follow up appointments as soon as possible. If
  these slots are not filled up a week before the
  date, then they revert to administrative
  appointment slots and the receptionist will fill
  them up as usual.

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• These reserved appointment dates may be used for
  root canal therapy, surgical extraction, and
  patients who have several decayed teeth or urgent
  needs (e.g., extractions before surgery
  children, diabetics or pregnant women with
  abscessed teeth).

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• It may also be used as a buffer to re-schedule
  patients who have to be cancelled for unforeseen
  reasons such as a provider calling in sick,
  employee meetings, or incremental weather, etc.

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• Patients who have waited three months for an
  appointment and are cancelled and re-schedule for
  another appointment three months away may forget
  the appointment or become discouraged from
  seeking routine dental care and resort to
  visiting the dentist only for emergency care.

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How it works

• Each dentist is given a blank appointment form
  on the 15th of preceding month to fill up and
  give to the receptionist on the 15th of the
  following month. The blank appointment form
  already has the time slots printed on it, and
  three columns for the patients name, chart
  number and type of appointment/treatment.

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• On the 15th of the month, the receptionist
  collects the completed forms and enters the
  appointments in the computer. The receptionist
  fills up any empty slots.
• works best for clinic sites with 2 or more
  dentists.

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• 3. To avoid any confusion, those dates should be
  blocked until opened up by the assigned/authorized
  receptionist. Only one person, per clinic site,
  should be assigned/authorized to enter these
  completed forms and open up the blocked slots.
  After the slots are open, any other person may
  fill them up.

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NOTE Toothache (TA) and exam slots will still be
filled by the receptionist and not by the
dentist/hygienist.
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Advantages

• 1. Persons who need immediate attention, per the
  dentists clinical judgment, do not have to wait
  for months for the next available appointment
  e.g. Need dental treatment before major surgery
  have rampant caries and need to be stabilized
  patient with cellulites need RCT diabetic
  and/or pregnant patients need pulp cap.

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• If for any reason, a dentist cannot show up for
  work or the clinic has to be closed, patients can
  be rescheduled within a month.
• 3. Fewer dissatisfied patients.

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• 4. Fewer broken appointments. The closer the
  appointment the less likely for patients to
  forget about it. About one-fourth of
  appointments will be in a month or less.

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• 5. Reduces the disease prevalence/germ load (i.e.
  number of persons with untreated decayed teeth).
  Since dental caries and periodontal disease are
  transmittable diseases, this will reduce the
  number of carriers and benefit the
  community(?).

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• 6. More treatment plans will be completed and at
  a faster pace (especially for RCT patients).
• 7. Greater job satisfaction for providers. Have
  some direct control over appointments and see
  more treatment plans completed.

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Disadvantages

• 1. Will take longer to get a routine appointment,
  since open appointments will be reduced.
  (However, the proportion will not be equal to the
  number of reduced slots, since some of these
  patients will be receiving the reserved
  appointments.)
• 2. Some dissatisfied patients, because of longer
  wait for routine appointments.

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Software Requirement

• A computer system that allows the dental
  director or an assigned/authorized receptionist
  to block out the last or first week of every
  month, and open those appointments as needed.

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SIZE MATTERS

• 1 dentist-clinic Q system a must
• 2 dentists-clinic should have system
• 3 dentists-clinic may have system
• 4 dentists-clinic Q not needed, but

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Conclusion

• The Q- Appointment System allows the provider to
  determine which patient has a medical necessity
  to override administrative appointments. It also
  provides a buffer for unforeseen circumstances
  such as absence of the provider for any reason or
  incremental weather.

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Root Canals

• Torabinejad, Ung Kettering JOE 199016566-569
  used root canals obturated with lateral
  compaction and placed a bacterial mixture over
  the exposed gutta percha (to simulate bacteria in
  saliva on a tooth with no restoration).  They
  reported complete bacterial penetration (Staph
  epidermidis) to the apex in 19 days in 50 of the
  cases.