Every day, frontline staff are required to ensure patients in need of an emergency appointment receive appropriate attention. Patients experiencing acute problems, like dental trauma, severe dental or facial pain, may require immediate treatment from a dental professional. However, prioritising appointments according to the urgency of cases requires a great level of skill and empowerment, which is not always present within the frontline team.
Reception staff, practice managers and/or dental nurses are often responsible for the diary. They have a huge effect on the smooth running of a practice, and are tasked with ensuring patients are greeted appropriately, and that their expectations are met, whether in urgent need of attention or a routine check-up. Getting the balance right can be tricky.
Although recommended to assist in effectively prioritising care, there is currently no requirement for members of the wider dental team to undertake any formal training in triage. As well as potentially risking the safety of patients, this can lead to frustration – for patients and the team alike.
From the pandemic and beyond
The recent Covid-19 pandemic forced the introduction of different processes for allocating emergency appointments, allowing for the remote triaging of patients. New technology and innovative workflows offered clinicians new opportunities for patient communication, and new approaches to patient prioritisation. Empowering the frontline dental team with flowcharts and guidelines during the pandemic highlighted the benefits of effective triaging in the management of emergency patients across the country.
The need for triage is no less important post-covid. In 2021, it was recognised that the backlog of treatment delayed during the pandemic would lead to a ‘tsunami’ of urgent dental problems. Indeed, in many areas, patient need currently outstrips provision, which reinforces the importance of adopting effective triaging processes across the dental team. With appropriate training, frontline staff can contribute more formally to the process of prioritising the right patients.
Empowering the team
Receptionists, dental nurses and practice managers have an important role to play in urgent dental care. The addition of multiple unscheduled appointments to the diary can add a great deal of added strain to a dental professional’s working day. Research has shown that time pressure is one of the major causes of stress for dentists, and a common cause of conflict between clinicians and reception staff. Emergency appointments can be short and are often double-booked, with limited time for the dentist to successfully diagnose and provide treatment for these patients.
However, frontline staff also feel the pressure. In a pre-covid study, a number of dental nurses reported they were under strict instructions to ensure all patients were allocated non-scheduled appointments, regardless of the number of appointments already in the diary.
Empowering staff has long been shown to improve engagement levels and performance and a study on health care workers commissioned during covid showed that empowering frontline staff also reduced stress levels and enhanced communication. To truly empower staff, they must be provided with the right knowledge and skills.
From triple A to complex protocols
With the appropriate training, tools and guidance, experienced dental nurses and reception staff can safely follow decision-support flowcharts to determine the urgency of a patient’s problem and triage accordingly. We already know this works. During the pandemic, guidelines and flowcharts produced by NHS England and Scottish Dental Clinical Effectiveness Programme (SDCEP), for example, allowed many patients to be successfully managed remotely by the ‘AAA’ approach of advice, analgesia and antibiotics.
Patients may present as an emergency patient for a variety of reasons, from trauma, severe pain, or orofacial swelling, to a lost crown or filling. These problems have a range of approaches and complexities, and the time required as well as the urgency of treatment for those problems can vary significantly. By following appropriate triage protocols, more information can be gathered from patients to treat them within the correct timeframe, with the right appointment length for their condition.
All members of the dental team should receive formal training to assess and interpret symptoms, assign urgency to clinical need, and provide simple, practical advice regarding oral hygiene and analgesia. For example, Orajel is a great oral analgesic to recommend to patients needing rapid relief from dental pain. Patients can apply Orajel directly using a clean finger or swab up to four times daily, giving them targeted control over pain management. This improves patient comfort while they wait for an appointment to see the dentist, relieving some of the pressure on staff.
Implementation of a formal dental triage system can help frontline staff manage diary pressures and patient expectations. Awareness of what constitutes a true emergency, and how long an emergency appointment is likely to last makes more efficient use of surgery time. Gaining the confidence and skills to improve patient comfort, and contribute to positive outcomes, can lead to a happier, more empowered team.
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