Providing Dental Services in the Hospital Setting

Susan Boisvert, BSN, MHSA, Senior Patient Safety Risk Manager, and Nichole M. Pieters, MS, RN, Patient Safety Risk Manager II, The Doctors Company, Part of TDC Group

Patients present to an acute care facility for many reasons, including emergency care, admission for ongoing treatment, surgical care, and—with surprising frequency—dental care needs. The American Dental Association (ADA) estimates that every year, 2 million patients visit emergency departments (EDs) for care that could be provided in dental offices.¹

Patients may seek emergency care because dental services are unavailable. According to the Health Resources and Services Administration (HRSA) data, 58 million Americans live in areas with limited access to dental care. Existing and projected shortages of dentists, hygienists, and dental assistants exacerbate access to care challenges.

When asked, patients often identify the cost of dental care as a barrier. A 2020 report of medical expenses indicated that patients were spending much more out of pocket for dental care (37 percent) than for physician (7 percent) and hospital care (12 percent) combined.² In addition to limited access and cost concerns, as many as 91 million U.S. adults may not have access to dental insurance—which makes hospital EDs an accessible alternative.³

When patients ignore preventive care, underlying dental conditions, such as abscesses and sepsis, may progress to life-threatening conditions that require hospitalization. Dentists and oral and maxillofacial surgeons may be appointed to a hospital’s medical staff to provide dental services to ED patients and inpatients when needed.

Opportunities also exist to improve access to outpatient dental care. The ADA recommends that hospitals and dental practices collaborate to develop a referral system to address patients with dental needs that do not require ED care. According to the ADA, appropriate dental referrals could save an estimated $1.7 billion in ED expenses. For more information, please visit ADA Emergency Department Referrals.

Risk Management Strategies for the Hospital Setting

Compared to dental practices, hospitals have complex organizational, leadership, and patient care structures. Lack of familiarity with hospital systems and medical staff rules may pose risk management implications for dental care practitioners, patients, and hospitals. Consider the following strategies to help you navigate the hospital environment.

Collaborate with the medical staff services department. In addition to overseeing credentialing and privileging, the medical staff services department may provide access to medical staff bylaws and hospital policies and procedures, coordinate continuing education, and distribute routine communications.

Request a medical staff orientation. Federal and state laws, accrediting bodies, and third-party payer contracting agreements heavily regulate professional staff in the hospital environment. Dental professionals practicing in a hospital setting must familiarize themselves with these expectations and recognize the differences between in-hospital practice and practicing in an outpatient setting.

Dental practitioners are encouraged to ask for and participate in hospital orientation. Orientation elements should include event reporting, role-specific and all-hazard disaster plans and emergency procedures, chains of command, medical staff and committee structures, and an overview of ancillary and support departments.

Hospitals must develop and make medical staff bylaws, rules, and regulations available to all credentialed medical staff. Dental practitioners are encouraged to review the documents with careful attention to patient record documentation expectations, interprofessional communication, credentialing, and privileging. Hospital privileges address the scope of practice for providing dental services in the hospital. Dental practitioners should provide a copy of hospital privilege documents to their professional liability insurer.

Evaluate equipment and support staff availability. Dental practitioners planning to provide services in a hospital must carefully review the available equipment and skills of ancillary support staff. Academic medical centers associated with a school of dentistry are much more likely to have appropriate equipment and staff with dental skills than a community hospital.

Dental practitioners who are considering bringing in outside equipment or hygienists should check with the hospital to determine if the hospital permits outside equipment and support staff and the appropriate approval process. Depending on the hospital’s requirements, it can take a considerable amount of time to finalize arrangements. To avoid delay in accessing the equipment and staff needed to provide safe patient care, address requirements as soon as possible. Seek assistance from the medical staff office.

Determine how billing and payment will be handled. Hospital billing is very different from outpatient dental billing. The billing department, or the departments in which dental practitioners provide patient care, may offer billing and payment guidance. Stay up to date on commercial insurance, Medicare, and Medicaid requirements. In addition to the billing department, hospitals ordinarily have clinical documentation specialists or improvement teams. These individuals are helpful with respect to the documentation needed for reimbursement.

Clarify expectations. Team communication in a hospital environment is complex. Practitioner-to-practitioner communication is vital. Ensure that all care team members understand the dental practitioner’s role and scope of care. Address any confusion and clarify causes for concern.

Formalize handoff communications. Critical patient information may get lost during transitions of care. To mitigate the inherent risks of patient handoffs, actively engage in a team communication training program such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety). These programs are designed to hone teamwork and team communication skills to ensure the delivery of safe patient care. Sometimes, participation in these programs is a requirement of the hospital. If not, seeking self-education around these and other structured communication tools such as I-PASS is a highly recommended risk management strategy. For more information, access the TeamSTEPPS 3.0 Pocket Guide.

When carefully managed, providing dental care to patients in the hospital can be a win-win for all involved.

For additional strategies and assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com.

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