In our last post, we shared how Dr. Ramona English, Chief Dental Officer at Petaluma Health Center (PHC) in Sonoma County, California, used quality improvement (QI) strategies to maintain and improve her practice in a time of drastic change. With this post, we will dive deeper into specific strategies Dr. English and her team use to prepare patients for teledentistry visits.
One particularly valuable lesson Dr. English and her team learned was the importance of dedicating time and resources to patient communication. They made a point to educate patients and their parents/caregivers about how to prepare for visits. This included publishing information on their website and in their patient newsletter, training front office staff and providing them with scripts, and creating patient education materials, including:
· Brochures and Fact Sheets: The team developed a series of one-page brochures, with detailed photos, including a snack guide and tips for positioning the child during tooth brushing. These photograph-filled brochures allow the Petaluma team to text visual aids to the patient's parents before the visit.
· Instructional Videos: Dr. English and her team quickly learned they needed good intraoral photos from parents ahead of a tele visit. Examining teeth via live video did not always provide the required level of detail to make a diagnosis. So, they created videos with examples and instructions to teach parents how to take full mouth photos of their children's teeth. Parents submit these photos in advance of the visit, and the dentist uses this information to support the video examination to make a diagnosis.
· A Patient Visit Preparation List: The list explains to patients how the teledentistry visit will work, what they should have ready for a successful visit (e.g., toothbrush, toothpaste, phone with a camera), and what to submit in advance (patient photos).
· Self-care Packages: The team tested mailing self-care packages in advance of the teledentistry visit. A challenge Dr. English and her team encountered was figuring out how far in advance they would need to mail the self-care packages, what exactly it should contain, and how to work with the clinic’s mail staff. They now send patients a self-care kit one week ahead of the appointment. The kit contains:
- Toothbrush and toothpaste - Pair of gloves
- Gauze - Fluoride varnish with applicator
- Flossers - Patient bib
- Disposable mouth mirror - A fun sticker (the kids love them!)
If staff schedules an appointment last-minute, the family receives a kit afterward. The office staff then schedules a brief follow-up to coach the parent on the fluoride varnish application.
"We had a demonstration [of a teledentistry visit] with the front office staff, and after experiencing it firsthand, they could easily explain the visit and its benefits to our patients."
-Dr. English, Petaluma Health Center
Dr. English and her team will continue to test new PDSA (Plan-Do-Study-Act) cycles each week, striving to improve the patient experience. Though still refining their process and testing for improved efficiency, PHC has found what works for them at this time. By transitioning some of their non-emergency care to teledentistry, Petaluma Health Center has shown great success with their program. They have reduced their need for PPE and prevented patients from ending up in the ER or OR, all while maintaining positive patient outcomes, and continuing to provide high quality, patient-centered care. Thank you, Dr. English and Petaluma Health Center, for laying the groundwork for other practices during a pivotal time.