Urgent Care Appointments – Policies and Procedures

Urgent Care Patients from Student Portfolio

• Students are required to see their own patients for urgent care in one of their assigned cubicles for the appropriate discipline wherever possible (e.g., CC: Pt in pain of suspected pulpal origin- book in Endo, broken tooth-book in Operative or Gen Dent)

Urgent Care Patients for patients of record

• Students assigned to the OCA (Out-of-Clinic-Assignment) for Urgent Care may be required to treat other students’ in- portfolio patients (for example, if the student is on a hospital rotation) or patients from the OCA Recall waitlist/pool, SSMD Hygiene pool, other patients of record of the school of Dentistry, or new patients from the community who contact the school seeking treatment for urgent dental needs
• Treatment in UC Clinic should be to relieve pain or to address the urgent chief complaint for the patient.
• The student assigned to the OCA UC should research the history of the chief complaint noting if it is due to recent treatment or a new problem to ensure proper use of the appropriate treatment code.
• In rare cases where the patient is a comprehensive patient of another student, the transfer of care back to the student responsible for these patients’ continuing care should include a detailed summary in the EDR and an email notification to the student that the patient was seen in Urgent Care. This will ensure that the comprehensive care student can proceed accordingly with the next steps.
• If the patient is from the OCA Recall pool, then a decision MUST be made as to where the patient needs to be referred for next steps:

o The patient may have all their needs cared for in this one-time Urgent care appointment. In this case, please leave the patient on the OCA Recare waitlist.

o The patient may need to be referred to Endo or Oral surgery.
o If a referral is needed for Oral Surgery, the student is to complete the Oral Surgery Case

Complexity Form in the patient’s EDR and the necessary paper OS slip (green slip) and present the case to the Oral Surgery Faculty Clinician. If deemed suitable for the school, the signed and approved slip is handed in to the front desk, and they will book the patient into an OS appointment.

o If a referral to Endodontics is required, complete the Endodontic Case Complexity Form in the patient EDR and present the case to an Endodontic Faculty Clinician. If the case is deemed appropriate for treatment at the school, the patient is to be placed on the Endodontic Waitlist.

o Depending on the case complexity and the patient needs, the patient may be deemed to benefit from a new comprehensive oral examination and treatment planning (DPR/OD). In this case the patient needs to be placed on the ODDP waitlist and removed from the OCA Recall list. This may be more often the case as a patient requiring endodontic therapy or extraction may require additional treatment after the immediate treatment, such as crown and bridge, implant, or removable options. These more complex restorative options would certainly warrant a comprehensive examination to allow for thorough and appropriate treatment planning and patient education about their treatment options.
o The urgency of the treatment will dictate which of the two above routes will be taken. (Endo/Exo as limited tx versus a comprehensive examination DPR/OD)
o After immediate treatment in Endo or Oral Surgery, a decision still needs to be made as to whether the patient requires further treatment via an Oral Diagnosis appointment (comprehensive examination and treatment planning) or remains on the OCA recare list for regular hygiene maintenance.

Urgent Care for New UC Patients who are not a current patient of record

• To review the patients’ Medical, Dental and Social history, as well as review the patients’ chief complaint
• Confer with the Attending DDS Clinician discussing initial findings, differential diagnosis, needed radiographs etc.
• Provide specific informed consent for treatment. This includes the discussion with the patient all aspects of informed consent including but not limited to: risks, benefits, alternatives, risks of not proceeding with treatment and costs. Please note that consent “2.11-Consent and Understanding for Emergency Treatment”, should be reviewed, appropriate treatment entered and signed. This consent does nto guarantee ongoing tx at the school.
• Treat the patient or refer; to relieve the patients’ pain/chief complaint
• If a referral is needed for Oral Surgery, complete the necessary OS Case Complexity Form in theEDR and complete the paper green OS slip and present the case to the OS Clinician. If deemed suitable for the school, the signed slip is handed in to the front desk, and they will book the patient in an OS clinic.
• If a referral for Endodontics is required, complete the Endodontic Case Complexity Form and present the case to the Endodontic Faculty Clinician. If the case is deemed appropriate for treatment at the school, the patient is placed on the Endodontic Waitlist.
• If the patient has a dentist in the community, write a letter to the patients’ Dentist to inform them in detail of treatment completed in Urgent Care/Oral Surgery or Endodontics.
• If a patient does not have a dentist, then the student should complete a cursory examination to assess whether there is more treatment that the patient might require that would be suitable to be treated at the Adult Clinic. The findings should be confirmed with the attending clinician. The patient should be asked if they are interested in becoming a comprehensive patient at the school. If not, the patient can be dismissed with this refusal for additional treatment clearly documented in the appointment record, in THE SCREENING TAB UNDER ORAL DIAGNOSIS AND IN THE DIARY NOTES.
• If the patient is suitable and is interested in comprehensive care, in most cases, it is preferable to screen the patient at this UC appointment wherever possible (see below**), rather than bring the patient back for a screening appointment.

Please remember that only one examination code can be charged for each appointment. The most appropriate code should be used. In a case where an emergency exam (01205) or a specific exam (01204) was completed, but a screening exam was completed at the same appointment and the patient was accepted as suitable, it is preferable to use the screening examination code (05201) to easily identify in the patient EDR and ledger that this was completed. The fee for all of the above exams is the same.