May 2020 Volume LV Number 3

 
 
 
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Policy Center Updates

March 2020 Volume LV Number 2

Evidence-Based Dentistry (EBD) Committee Update
Three new topics deemed of greatest importance to provide timely guidance to clinicians have been approved by the Board of Trustees:
  • Frenectomy/frenotomy and lactation,
  • Vital treatment of immature permanent teeth, and
  • Caries risk assessment and oral health determinants.
The EBD Committee continues to oversee the evidence-based clinical practice guidelines currently under development:
  • Clinical Practice Guidelines for use of Non-Vital Pulp Therapies in Primary Teeth,
  • Clinical Practice Guideline on Behavior Guidance for Pediatric Dental Patients, and
  • Clinical Practice Guideline on Frenectomy/Frenotomy and Lactation for Pediatric Dental Patients.
The Non-Vital Pulp Therapy Workgroup is in the final stages of the systematic review and therapy clinical practice guideline, both scheduled for publication in 2020. The Behavior Guid- ance Guideline Workgroup is awaiting the publication of the Cochrane systematic review on "non-pharmacological interventions for managing dental anxiety in children" and have added two new content experts to their team. The table in the PDF attached indicates the timeline of clinical practice guideline development.

Practice Characteristics: Insights from a National Survey
 
Though tax season is nearly upon us, why not take a break from your QuickBooks reports to audit these alternative attributes of your practice? Below are results from the AAPD’s 2017 National Survey of Pediatric Dental Practice, which reviewed topics ranging from practice demographics to service capacity to patient characteristics, and more.


How does your practice stack up to the national average?
 
Does your practice serve teenagers?
26 percent of pediatric clients are teens, according to the national survey of 13-18 year olds seen at pediatric dental practices.
 
What portion of your patients are newborn though age 2?
13 percent of pediatric clients are age 2 or younger in the typical pediatric dental practice.
 
Private, public assistance or neither: what is the breakdown of the types of insurance covering your pediatric patients?
55 percent of pediatric patients have private insurance,
34 percent of pediatric patients have public assistance, and
11 percent of the kids you see don’t have insurance at all.
 
What is the average number of weeks per year that you work in your practice?
46 weeks out of 52 total –An excellent reason for scheduling that vacation you’ve been thinking about!
How long do your patients wait to schedule an appointment?
10 days for patients of record according the survey, and
12 days for new patients.
 
How long do your patients wait to be seen after they arrive for their scheduled appointment?
7.5 minutes for patients of record
8.5 minutes for new patients
 
How many patient visits do you have per hour (excluding hygiene)?
3.3 patients per hour 90 patients per week 4,134 patients per year!
 
How many cases per month involve in-office anesthesiology?
10.5 cases each month and this number is trending up.
 
Do you use an operating room in a hospital or accredited surgical facility?
62 percent of you do, and on average 14 cases are treated there per month.
 
Does your practice provide charitable care?
77 percent of pediatric dentists provide charitable care.
  • And, on average, the value of care provided free of charge is $18,260.50.
  • You reduce patient rates approximately 30 percent for charitable care, which amounts to about $43,708.
Are You Keeping Your Practice Safe?
 
A selected set of practice tools is now available on the AAPD website to help identify dental practice safety concerns and take action to im- prove the safety of patients, staff and the environment. This collection of resources contains current recommendations in major areas of dental practice related to safety, using best practice guides, policies, training materials and office-friendly tools. Bookmark the Safety Toolkit now on the AAPD Resources webpage and check back often as new topics and resources are released!
 
Feature topics include:
  • Medication error reduction systems
  • Water line safety
  • Nitrous oxide safety
  • Physical plant safety
  • Medical emergencies in the dental office
  • Personnel security
  • IT security
  • Dental records and record keeping
  • Developing a culture of safety
  • Comprehensive informed consent
  • Sedation and general anesthesia
  • Infection Control
Access the Safety Toolkit under Resources on the AAPD website at www.aapd.org.

Making a Commitment to Safe Care: My AAAASF Certification Experience
By Barry L.  Jacobson, D.M.D.
 
Obtaining certification has been one of the best investments I have made. Safety and compliance initiatives for the benefit of better qual- ity of care and a safer environment for the patients is a mission state- ment that everyone can get behind. It transcends employee/employer boundaries, it unifies doctors and staff, and it clarifies the goals and objectives of the organization. I have been a pediatric dentist for over twenty years, having gone through Board Certification and Recerti- fication. I went into private practice upon graduation and four years later, following my appointment as a Pediatric Dental Section Program Director, I founded a Pediatric Dental Residency Program at a major New York academic medical center. After a ten-year run as program director, I returned to private practice, where for the past 24 years, I have operated my own practices and have purchased a number of existing practices. I now own and operate 18 pediatric dental practices in three states with over 40 pediatric dentists in my employ. I have  seen many management styles, personality types and team building initiatives come and go. But, throughout my career, I have found that The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) certification has been a significant impetus to positive change in the delivery of patient care and in the operations of my practices.
 
AAAASF certification is a significant undertaking that requires the commitment and effort of the whole organization. Specifically, it requires that the dental practice step back and objectively review all systems related to patient safety and quality of care. AAAASF pro- vides a roadmap that starts with staff and training, reviews infrastructure and equipment upgrades necessary to meet all modern standards, and ends with random case reviews and reporting of all morbidity  and mortality. In short, it is an intensive and comprehensive process to obtain and keep certification, but a dental practice must take steps
to ensure the consistent provision of safe and high-quality care to all patients. These efforts and outcomes alone make obtaining certifica- tion an important exercise for any dental practice.
 
Moreover, obtaining AAAASF certification is an excellent team- building experience. It clarifies goals and objectives, separates team leaders and followers and identifies facilitators versus objectors.
 
During the process of obtaining certification, there will be many opportunities for personal growth and staff education. The organiza- tion benefits don’t end there. Because of the continuous and ongoing reporting requirements of AAAASF, maintaining certifications ensures a continuous process of  performance improvement and provides bet- ter identification of organizational or individual problems.
 
Going through the process of obtain- ing certification will help you identify team players as well as passive and active resistors. Obviously, anyone who doesn’t get on board and share your organiza- tional values and goals – or who puts themselves, their egos, or their comfort before the organization’s goal of improving quality and safety – is someone you may want to con- sider undertaking corrective action or discharging from your practice. Often times these passive or active resistors may be holding back  your practice in many other areas as well. Anyone who is passively or actively resisting your efforts to make your office safer and provide a higher quality of  care is likely resisting your initiatives in many other areas. In light of this, obtaining and keeping AAAASF certification is an essential tool in identifying problematic personnel and practices and instituting prompt corrective actions. Use the opportunity to make changes to your practice that you have been neglecting or avoiding. In effect, certification can be an agent for positive change in your practice.
 
AAAASF is a continuous and ongoing process that will take your time and effort, but it is well worth your while. I recommend that you schedule yourself and your staff for 8 – 12 weeks to review all the parts of the certification self-survey. Do a walkthrough with key personnel, identify projects, and delegate tasks. Schedule regular weekly meetings to review progress and keep on track with timelines. Because the ulti- mate goal of certification is so important, consider planning a reward dinner for the staff to celebrate their efforts and commitment to safety and  quality.
 
AAAASF will be there every step of the way, operating not only as an inspector of your practice, but also as a facilitator who is commit- ted to helping you achieve and maintain certification. In your daily life and everyday practice of dentistry, it is hard to keep all the balls in the air. AAAASF helps you with quarterly reminders for reporting, up- dates on national standards, and notification of public health notices, etc. I encourage anyone who does sedation in their offices to strongly consider engaging AAAASF to help you in your journey. To the extent that more and more dental practices will become certified, I believe it will greatly benefit our profession and our patients. I therefore strongly recommend that you consider pursing AAAASF Certification in your practice.

Click here for a PDF version of this article.