How is your clinic run? Temple is changing and we need ideas.

[1992Corolla]

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As many of you know, Temple has a new dean and things are changing around here in the next two years. I have been asked to be on a clinic committee and am asking for some good and bad of how your clinic runs. What works and what doesn't.
Please address the following and anything else you think works and doesn't work:

Scheduling: How do you schedule patients? How far in advance can you schedule patients? Can you make a limited number of appts at a time? etc.

Charts: Who holds your charts? How do you get them?

Sequence: How do your clinics work? For example right now at Temple the 1st/2nd appointment are usually admissions and then treatment planning. The next appt is in perio. Here the patient is deemed as a 1/4, 1/2, or full case. The perio is done before they can move on to other clinics (concurrent treatment form can be signed). Dentures and fixed can take several appts. etc. Please elaborate on what works.

Amount of patients: How many can you see in a day? What works? What doesn't?

Faculty: How many faculty:student ratio? Who checks off the work? How are the group practices set up (for those of you in them).

Sterilization: One location? Several locations? How does it work?

Emergency: How do emergency patients get treated (your own and walk ins)

Insurance/Billing: elaborate what works and what doesn't

Own chair or random chair: Do you like having your own chair? Do you like getting a random chair in a clinic? What works and what doesn't?

Anything else you think works really well at your school.

Temples big issue right now is inefficiency. It takes several appointments to get some patients through the various clinics and we want to make some changes.

 

[armorshell]

Scheduling: Patients are scheduled by us, online. Patients can be scheduled for anytime throughout the quarter. Each department has a number of chairs assigned to it that get filled up first, then a number of waitlist spots. Next year this will change to the Axium scheduling system, which I understand is very similar.

Charts: Currently charts are held in the basement chartroom, and are picked up by the students. The clinic is going paperless next year though, so they should all be accessible online.

Sequence: Patients initial visits are either through faculty screening or the emergency clinic, after which the patients are scheduled for an FMX or instructed to bring a recent FMX from their dentist. The patient is then triaged by a group practice administrator to a student dentist, who appoints them for an ODTP (Oral diagnosis and treatment planning). This includes a medical history, head and neck exam, perio and hard tissue exam and diagnosis along with treatment planning, and ranges from >1 clinic session to 2 full clinic sessions depending on the complexity of the case and the faculty you work with. Note that clinic sessions at Pacific are 3 hours.

Next is perio, which depends on the diagnosis reached during the ODTP. For new patients it's either prophy or S/RP, most recall patients get what the school calls "supportive perio therapy", which is basically whatever the patient needs.

After you're out of the perio penalty box, you do anything and everything the patient needs. Fixed takes 3-5 appointments, removable takes 5.

Amount of patients: This all depends on the year, the student, and the procedures. D2s are scheduled to be in clinic 1 3 hour session per day + 3 night sessions per quarter (I've done 5 though already and the quarter is only haldf over), D3s 2 3 hour sessions per day. If you have an easy exam on 1 patient and an impression on another, you can easily double book and do both in one session, I've done it a bunch of times. Seems to work pretty well.

Faculty: Depends on the department. Perio faculty are usually stretched pretty thin, which is easy because at UoP you only need a start and finish check from perio (Ratio about 1:10 plus ODTP perio diagnosis checks), restorative is around 1:6, endo for me has always either been 1:1 or 1:2. Work is checked off by the specialists in the department you're working in.

Sterilization: One location. Central sterilization delivers catridges to two dispenseries located in the clinics. Works okay, they need to find a way to guarantee the right number of kits for each procedure, but they've only fallen short 1 or 2 times this year so far.

Emergency: Walk in's get treated in the emergency department which has a dedicated attending and D3's on rotation. All they do is accesses, referrals to oral surgery and palliative fillings (or nothing). If it's your own patient, you can either send them to emergency or schedule them. If you have a patient with an emergency, most of your other patients are understanding if you have to reschedule them.

Insurance/Billing: We take all insurances, plus Dentical (CA state dental insurance) and Ryan White/CARE (Free dental care for HIV+ SF residents). Patients must get financial approval before beginning treatment by either having insurance, signing a payment plan, or pre-paying. If patient have financial approval, you do tx and they default, you DO NOT lose credit and are not responsible for collections.

Own chair or random chair: Random chair. It would be nice to be able to keep all your stuff in your own chair, but the amount of stuff I lug around fits in a small tote bag. Central sterilizations eliminates the need to lug tons of stuff, and I've never had any problems getting a chair whenever I've needed one. I honestly can't think of a single time I haven't gotten a chair on the day I wanted.

Responding in quote, let me know if you need elaboration.

 

[1992Corolla]

Thanks Armor, anything that doesn't work or some things that the students tend to gripe about the most?

Also: if there are problems, is there a weekly council with faculty and students to solve the problems?

Keep them coming guys!

 

[tinman831]

Scheduling: How do you schedule patients? How far in advance can you schedule patients? Can you make a limited number of appts at a time? etc.
We are limited to 18 active appointments for 3rd year students and 22 active appointments for 4th year students at any given time. If you have the maximum appointments scheduled already, you may not schedule another until you use up one appointment. We used to do a free-for-all at the beginning of the month where it was first come first serve (I would have liked this idea better since I can't get enough chair time for my patients). This wouldn't be good if youre lazy and aren't on top of things.

Charts: Who holds your charts? How do you get them?
Everything is computerized here. Once you're assigned a patient, you automatically have access to their chart on the computer.

Sequence: How do your clinics work? We do things in phases here too. Initially we do an examination. Then all the perio work gets done next. Only when we completely finish perio and their health is stable do we move on to restorative. This makes sense and seems to work out fine.

Amount of patients: How many can you see in a day? What works? What doesn't? There are 3 clinic sessions a day so you can see a total of 3 patients. 3 hours per patient. You really don't want to shorten that time any more or increase that time.

Faculty: How many faculty:student ratio? Who checks off the work? How are the group practices set up (for those of you in them). Each class is divided up into group practices with about 25 students in each. Examinations are checked by group leaders (general dentists). Any actual treatment being done is covered by a resident or specialist in that given field (prosth, operative, perio, etc). Usually there is up to 5 students for each specialty for any given clinic session. Although it can get hectic when you have questions and the instructor is busy with other students. You can never find your instructor when you need them. 😛

Sterilization: One location? Several locations? How does it work? We have dispensaries on each clinic floor who distributes instruments. They are then turned in at the end of the clinic session to be sterilized at central sterilization.

Emergency: How do emergency patients get treated (your own and walk ins). We have our own emergency department covered by a resident and students on rotation who treat walkin's. If our own patient has an emergency, we will see them if possible, otherwise another student will see them.

Insurance/Billing: elaborate what works and what doesn't. We take Massachusetts Health, which requires pre-approval for every treatment beforehand (aside from exams, cleanings). It's a pain in the butt to have to request funding for every treatment we do. We also take another insurance company and we accept Ryan White like Armorshells school. Any other insurance company, the patient will have to send out for reimbursement.

Own chair or random chair: Do you like having your own chair? Do you like getting a random chair in a clinic? What works and what doesn't? We are assigned random chairs. We do not get our own chair. It'd be nice if we could but few schools actually do this. [/QUOTE]

 

[djeffreyt]

The biggest problems griped about tend to be with inconsistency among faculty. The ODTP appt Armor talked about it done with a certain set of faculty and they sign off on a treatment plan. You then move forward on that treatment plan, but once you start restoring (operative, fixed, removable) there is a chance that faculty in the restorative departments will have a different idea bout how the patient needs to be treatment planned and this may derail the current plan and set you back a step.

This can be gotten around with a little ingenuity and proper planning and confidence in your own ability to treatment plan correctly, but it still hits people from time to time.

The other issue is that at the beginning of clinic session, you need to get your sterilized instruments from 1 of 2 main dispenseries, and there can be long lines and waits at these windows.

Oh, and a clinic committee meets every month with staff and the dean of clinics. The committee is made up of faculty and staff and 4 students from each DDS class and 1 student from each IDS class. Not all problems can be resolved via this committee, but many smaller problems get resolved easily and larger ones tend to take longer to figure out.

 

[jmick101]

Man, it is a bummer that there aren't more replies to this thread. I would love to hear how things work at other schools. Cmon guys, lets hear the goods!

 

[1992Corolla]

giggity. I have a meeting on the 21st, put down those midterm back tests and give me a good reply!

 

[g3k]

University of Minnesota

As many of you know, Temple has a new dean and things are changing around here in the next two years. I have been asked to be on a clinic committee and am asking for some good and bad of how your clinic runs. What works and what doesn't.
Please address the following and anything else you think works and doesn't work:

Scheduling: How do you schedule patients? How far in advance can you schedule patients? Can you make a limited number of appts at a time? etc.
You can schedule your patients at any of your open appointments for that semester until the next semester schedule is out. Typically we have to go through these rotations - radiology (3 weeks) , emergency (7 to 10 sessions), oral surgery (6 half week/ 3 full weeks), grad perio assisting (12 to 14 sessions), grad endo assisting (5/6 sessions), oral surgery assisting (3 to 4 weeks in third year), pedo (4 to 5 weeks), DAU (1 week) and outreach (6 to 8 weeks)- before we graduate. Some semesters you have more operative sessions than others depending on where and when you have these rotations.
Charts: Who holds your charts? How do you get them?
Records department holds our charts. We can request them online or by filling out forms. For appointments, our PCCs (front desk) generally hold them for us on the previous day, unless it is an emergency appointment. We have been asking our dean to computerize everything. They are still working on it. Charts suck. They go missing sometimes, they are with some other student/grad sometimes and sometimes the records cannot find them. Though this rarely happens, it is annoying when it happens.

Sequence: How do your clinics work? For example right now at Temple the 1st/2nd appointment are usually admissions and then treatment planning. The next appt is in perio. Here the patient is deemed as a 1/4, 1/2, or full case. The perio is done before they can move on to other clinics (concurrent treatment form can be signed). Dentures and fixed can take several appts. etc. Please elaborate on what works.
Typically, patients come into admissions. They fill out the necessary paperwork and get their full mouth radiographs. We have our rotations in IFC (radiology). During 3rd year we are rotated for a week or two every semester and during final year a few sessions are thrown in our schedule here and there. A faculty member fills out an assignment form with the patient needs after screening the full mouth radiographs. The assignment form is sent to patient assignment department. We are given a form to fill out what we need - operative/ fixed pros/ removable pros/ endo etc. Then depending on who needs what and whatever we have requested, we get patients assigned to us. The first one or two appointments typically are spent in treatment planning. Later depending on the patient's needs we schedule them in perio to begin with, followed by operative/endo followed by pros and then other needs.
Amount of patients: How many can you see in a day? What works? What doesn't?
In a day we have 2 sessions about 3 hours each. We can schedule how many ever patients we would like to see. Typically, during the third year we see one patient a session. Final year, students see 1/2/3 patients a session depending on their skill level.
Faculty: How many faculty:student ratio? Who checks off the work? How are the group practices set up (for those of you in them).
We have group practices. Each group has a CCC (Comprehensive care clinic) faculty and one or two operative faculty (usually part-time). Each group has an assistant and a PCC (front desk). 12 to 14 seniors and 12 - 14 juniors. We get an infection control check, a start check, a prep check whenever indicated and a final check. The boring thing is sometimes the wait time is long. Like the others mentioned, it is annoying when one faculty does not agree with the treatment plan. It is all about planning. As long as we schedule the patient on days when the faculty, who signed off the treatment plan, is around, it is not an issue.
Perio can be done in our own group chair or we can schedule it under perio chairs. Same goes with Pros. One area of the clinic is allocated for perio and another for pros. Endo is always done on endo chairs located next to the grad clinic area. Extractions are done in oral surgery by whoever is in that rotation.
Sterilization: One location? Several locations? How does it work?
Each floor has a sterlization area. Each floor has a north, central and south clinic. Typically the clean dispensing is located in the north and the dirty dispensing in the south. We rent instruments. Final years have their own operative kits (also rented... but each of us will have our own names on it.)
Emergency: How do emergency patients get treated (your own and walk ins)
They changed it this year. This year, emergency patients are divided as new emergencies and group emergencies. If a ptient is already assigned to a dental student and if the patient has an emrgencey, eaither the student or someone in the student's group will see the patient. New patients are seen by students who are rotated through ICC- Emergency clinic. It was better last year when we had emergency clinci on a different floor right next to oral surgery. We had a lot more patients for extractions. After the change, we feel the patient pool in oral surgery has gone down. I lucked out because I had my rotation in oral surgery last year.
Insurance/Billing: elaborate what works and what doesn't
I guess I didn't quite understand this question. Most of our patients are MA so insurance is automatic. From what I know our school takes all insurances. Each student is eligible to give 2 student discounts to any 2 patients - a 50% discount. Also, cash patients have a 5% off if their treatment plan costs more than $800.
Own chair or random chair: Do you like having your own chair? Do you like getting a random chair in a clinic? What works and what doesn't?
Random chairs. Own chairs would be nice. At outreach sites we typically have own chairs. There is never an issue for chairs. That is something UMN prides in... there are more chairs than students at any given point of time.🙄
Anything else you think works really well at your school.

Temples big issue right now is inefficiency. It takes several appointments to get some patients through the various clinics and we want to make some changes.

 

[1992Corolla]

any more...

 

[Huggies]

moved