DENTAL NEWS: Mitigating Referral Risks

This first appeared on OMSNIC, written by Julie Goldberg, DDS. It has been abbreviated. 

Full article here.

Referrals play a critical role in ensuring comprehensive patient care, allowing dental professionals to collaborate and provide specialized treatment when necessary. As an OMS specialty provider and the recipient of referral information, you may receive referrals that have incorrect or missing information. Referrals lacking accuracy or completeness may present risks, including but not limited to wrong site surgeries, delays in treatment and unrealized patient expectations. Mitigating complications associated with referrals first requires identification of the potential causative factors. Consider how each of the following may apply to the referral process in your office:

1. Miscommunication: Miscommunication between providers may lead to misunderstandings regarding the patient’s condition, treatment plan, and medical history. This may come in the form of lack of communication; errors in communicating either referral details, diagnoses or outcomes; errors associated with transfer of images; or a lack of documentation of the referral details.
2. Patient Expectations: Patient expectations may be set during a discussion with the referring provider. These conversations may include the time it may take to be scheduled for a specialty referral, what might be expected of the patient, and what treatment and/or anesthesia the specialty provider may offer.
3. Change in Patient Presentation: Referral processing times, patient-related delays, or appointment scheduling may impact referral requests and treatment plans. This becomes particularly important when considering treatment of the minor patient with mixed dentition, whose presentation may change quickly or for the patient whose symptoms simply evolve over time.

The following closed claim example illustrates how an independent assessment performed by the insured OMS exposed risks related to a change in patient presentation and doctor to doctor communication:

A patient presents to an OMS on referral from her general dentist, with a referral form requesting the extraction of teeth #’s 2, 3 and 31. The patient had delayed the visit to the OMS by a couple of weeks for insurance coverage reasons. The OMS documented that the patient reported pain on the right side for about two weeks duration, and that, based on testing and examination, the source of this pain appeared to be #2, 29 and 31. The OMS attempted to contact the referring dentist to explain his diagnosis, but the dentist was unavailable at the time of the call. 

Although the OMS urged the patient to delay care until he could speak to the referring dentist, the patient was in pain and requested that the extraction of #’s 2, 29 and 31 be completed that same day. The OMS documented a conversation with the patient about the likelihood of future extractions, including #3. The extractions were performed without incident and the patient visited the general dentist three weeks later for a cleaning appointment. At this visit, the dental hygienist informed that patient that “the wrong tooth was extracted” and that #3 would still need to be extracted according to the treatment plan. The patient became upset and filed a Board complaint against the treating OMS.

A delay in seeking treatment in this case might have altered the patient presentation, leading the OMS to recommend an alternate plan to relieve the patient’s presenting symptoms. Complicating this case was the inability of the OMS to reach the dentist to discuss the independent assessment and the dental hygienist’s comments at the next scheduled visit. Ultimately, with the assistance of OMSNIC defense counsel, the state Board dismissed the case with no probable cause.

Patients benefit when providers work together to ensure a coordinated referral process. Periodic evaluation of the effectiveness of referral management protocols may identify areas for improvement, and asking providers and staff to offer scenarios for consideration to test current policies and procedures will allow all members of the referral network to assist in mitigating risk as a team.

Read the rest of the article here.

Dr. Goldberg’s example includes three of the key complications with current referral processes:

1. Miscommunication between the referring general dentist and oral surgeon resulted in confusion about which teeth needed to be extracted. The two week delay to accommodate the patient’s insurance requirements caused further confusion.
2. As a result of the disjointed communication between the two dentists, inconsistent treatment instructions were given to the patient. Neither the general dentist nor the oral surgeon knows exactly what the other provider told the patient, leading to unclear patient expectations and retroactive headaches for all parties involved.
3. For urgent extraction cases like this one, patient conditions can change rapidly. A couple of days or weeks can result in different diagnoses. If all evaluations aren’t documented and dated perfectly, changes in patient condition can be lost amidst referral communications, resulting in oral surgeons doing procedures based on information that was current days or weeks prior.

Sindi is the solution for all three of these.

It enables general dentists to refer patients to oral surgeons on a single central platform with built-in chat features – allowing dentists and office managers to communicate in real time. Sindi tracks the referral process end-to-end – starting from when the referral is sent all the way through to when the Referral Visit Summary is returned to the referring dentist.

Every communication is saved in a referral log, ensuring treatment documentation is never lost in email threads, phone tag, or misplaced paperwork. 

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