Providing Dental Services in the Hospital Setting

Amy Wasdin, RN, CPHRM, Patient Safety Risk Manager II, Department of Patient Safety and Risk Management

Lack of familiarity with hospital systems can pose serious risk management implications for dental professionals.

Patients present to an acute care facility for a variety of reasons, such as emergency care, admission for ongoing treatment, surgical procedures, and specialized nursing care. Unfortunately, appropriate dental care is often overlooked or not identified as a priority at the beginning of a patient’s course of hospitalization.

Good dental care is an important component of maintaining overall health and well-being. When unchecked and untreated, bacteria that forms in the mouth can lead to more serious health problems. Poor oral care has been known to contribute to cardiovascular disease, respiratory infections, and other serious health conditions.

Dentists and oral surgeons are often appointed to a hospital’s medical staff to provide dental services to emergency department patients and inpatients when needed. They do not routinely provide general dental services but frequently provide emergent treatment indicated by oral trauma or infection.

Because of the infrequency of providing dental care in the hospital setting, many dentists are unfamiliar with hospital and medical staff requirements that apply to the providers who examine and treat inpatients. The lack of familiarity with hospital systems and medical staff rules can pose serious risk management implications for the dental care provider.

Risk Management Strategies

• Be wary of the “curbside consultation,” an informal collaboration that may find its way into the medical record. Dentists have been sued by patients they did not meet or examine because another provider documented inaccurate information in the medical record. If you are asked for input on a specific patient situation, it may be best to request a formal consultation so that you can document your thoughts and opinions in your own words.
• Communicate clearly with other providers on the expectations regarding your involvement in patient care. Once you become part of the care team, the lines can become blurred among providers regarding who is responsible for each aspect of care. Key information can get lost during the transitions that occur among caregivers in a hospital. Clarify your role in the record, and communicate with other caregivers when confusion or cause for concern occurs.
• Familiarize yourself with the medical record in advance—and ask for training. Electronic health records (EHRs) present special challenges to users who are not familiar with the system and its unique nuances. You may need to use templates or designated sections for your documentation. The EHR may not be easy to navigate, so it is helpful to take the time to learn about the sections that you will need to use. The EHR can be a powerful tool for provider collaboration if you know where to access information.
• Understand your documentation requirements. How often are you required to document your care of the patient? When does your documentation need to be finalized and available in the medical record? What do you need to include in your consultation notes? These questions should be answered at the time of your appointment to the medical staff.
• Request updates and revisions to processes and systems. Hospitals regularly update and revise facility operations as well as clinical policies and processes. Make sure that you periodically request updated information regarding any changes related to the facility or patient care. Notices about physical plant changes may prove extremely helpful to you when locating your patient to provide dental services. Notices of process changes will help you fulfill your obligation to follow current policies and procedures as a medical staff member.
• Have a go-to person to contact for assistance when needed. Despite taking appropriate steps to be prepared to care for your patient, unexpected challenges may occur. Get to know your medical staff department coordinator and the facility risk manager. They can prove to be great resources when you need quick access to information. Also, if you cannot find someone to assist you outside of regular hours, ask the on-call hospital administrator to connect you with someone who can assist.